National Provider Identifier [NPI]: |
1982899365 |
Last Name Of The Provider |
HERMES |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 NE MOTHER JOSEPH PL |
Street Address 2 Of The Provider |
SUITE 210 |
City Of The Provider |
VANCOUVER |
Zip Code Of The Provider |
986643299 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
45 |
Number Of Services |
296 |
Number Of Medicare Beneficiaries |
126 |
Total Submitted Charge Amount |
94796.42 |
Total Medicare Allowed Amount |
23552.82 |
Total Medicare Payment Amount |
17205.04 |
Total Medicare Standardized Payment Amount |
19562.48 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
39 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
1729.44 |
Total Drug Medicare AllowedAmount |
1345.51 |
Total Drug Medicare PaymentAmount |
949.74 |
Total Drug Medicare Standardized Payment Amount |
949.74 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
257 |
Number Of Medicare Beneficiaries With Medical Services |
126 |
Total Medical Submitted Charge Amount |
93066.98 |
Total Medical Medicare Allowed Amount |
22207.31 |
Total Medical Medicare Payment Amount |
16255.3 |
Total Medical Medicare Standardized Payment Amount |
18612.74 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
52 |
Number Of Beneficiaries Age 75 to 84 |
42 |
Number Of Beneficiaries Age Greater 84 |
13 |
Number Of Female Beneficiaries |
74 |
Number Of Male Beneficiaries |
52 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
107 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
33 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
70 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.189 |