National Provider Identifier [NPI]: |
1609189679 |
Last Name Of The Provider |
VAYL |
First Name Of The Provider |
GREGORY |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2202 HARLEM RD |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
LOVES PARK |
Zip Code Of The Provider |
611112754 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
68 |
Number Of Services |
293 |
Number Of Medicare Beneficiaries |
290 |
Total Submitted Charge Amount |
589320 |
Total Medicare Allowed Amount |
46505.74 |
Total Medicare Payment Amount |
36301.78 |
Total Medicare Standardized Payment Amount |
33618.39 |
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 |
68 |
Number Of Medical Services |
293 |
Number Of Medicare Beneficiaries With Medical Services |
290 |
Total Medical Submitted Charge Amount |
589320 |
Total Medical Medicare Allowed Amount |
46505.74 |
Total Medical Medicare Payment Amount |
36301.78 |
Total Medical Medicare Standardized Payment Amount |
33618.39 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
46 |
Number Of Beneficiaries Age 65 to 74 |
113 |
Number Of Beneficiaries Age 75 to 84 |
84 |
Number Of Beneficiaries Age Greater 84 |
47 |
Number Of Female Beneficiaries |
148 |
Number Of Male Beneficiaries |
142 |
Number Of Non Hispanic White Beneficiaries |
233 |
Number Of Black or African American Beneficiaries |
23 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
23 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
220 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
70 |
Percent Of With Atrial Fibrillation |
22 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
59 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.8027 |