National Provider Identifier [NPI]: |
1285774844 |
Last Name Of The Provider |
RUDDICK |
First Name Of The Provider |
GUY |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
FNP |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3231 S NATIONAL AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPRINGFIELD |
Zip Code Of The Provider |
658077304 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
338 |
Number Of Medicare Beneficiaries |
241 |
Total Submitted Charge Amount |
30067 |
Total Medicare Allowed Amount |
16514.95 |
Total Medicare Payment Amount |
10434.7 |
Total Medicare Standardized Payment Amount |
14314.38 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
48 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
414 |
Total Drug Medicare AllowedAmount |
158.7 |
Total Drug Medicare PaymentAmount |
122.88 |
Total Drug Medicare Standardized Payment Amount |
122.88 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
290 |
Number Of Medicare Beneficiaries With Medical Services |
241 |
Total Medical Submitted Charge Amount |
29653 |
Total Medical Medicare Allowed Amount |
16356.25 |
Total Medical Medicare Payment Amount |
10311.82 |
Total Medical Medicare Standardized Payment Amount |
14191.5 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
56 |
Number Of Beneficiaries Age 65 to 74 |
109 |
Number Of Beneficiaries Age 75 to 84 |
60 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
148 |
Number Of Male Beneficiaries |
93 |
Number Of Non Hispanic White Beneficiaries |
228 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
194 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
47 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
8 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
6 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
0.9211 |