National Provider Identifier [NPI]: |
1205924867 |
Last Name Of The Provider |
LIESE |
First Name Of The Provider |
ZIANA |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9100 W 74TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SHAWNEE MISSION |
Zip Code Of The Provider |
662044004 |
State Code Of The Provider |
KS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
1094 |
Number Of Medicare Beneficiaries |
435 |
Total Submitted Charge Amount |
293479 |
Total Medicare Allowed Amount |
106148.47 |
Total Medicare Payment Amount |
83004.49 |
Total Medicare Standardized Payment Amount |
83894.31 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
17 |
Number Of Medical Services |
1094 |
Number Of Medicare Beneficiaries With Medical Services |
435 |
Total Medical Submitted Charge Amount |
293479 |
Total Medical Medicare Allowed Amount |
106148.47 |
Total Medical Medicare Payment Amount |
83004.49 |
Total Medical Medicare Standardized Payment Amount |
83894.31 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
87 |
Number Of Beneficiaries Age 65 to 74 |
120 |
Number Of Beneficiaries Age 75 to 84 |
125 |
Number Of Beneficiaries Age Greater 84 |
103 |
Number Of Female Beneficiaries |
256 |
Number Of Male Beneficiaries |
179 |
Number Of Non Hispanic White Beneficiaries |
395 |
Number Of Black or African American Beneficiaries |
25 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
325 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
110 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
46 |
Percent Of With Chronic Kidney Disease |
61 |
Percent Of With Chronic Obstructive Pulmonary Disease |
47 |
Percent Of With Depression |
49 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
74 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
60 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
16 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.2252 |