National Provider Identifier [NPI]: |
1174661094 |
Last Name Of The Provider |
GOLDSBOROUGH |
First Name Of The Provider |
JENNIFER |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
CRNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
821 N EUTAW ST |
Street Address 2 Of The Provider |
#308 |
City Of The Provider |
BALTIMORE |
Zip Code Of The Provider |
21201 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
9 |
Number Of Services |
467 |
Number Of Medicare Beneficiaries |
301 |
Total Submitted Charge Amount |
105180 |
Total Medicare Allowed Amount |
51398.46 |
Total Medicare Payment Amount |
39818.53 |
Total Medicare Standardized Payment Amount |
44674.61 |
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 |
9 |
Number Of Medical Services |
467 |
Number Of Medicare Beneficiaries With Medical Services |
301 |
Total Medical Submitted Charge Amount |
105180 |
Total Medical Medicare Allowed Amount |
51398.46 |
Total Medical Medicare Payment Amount |
39818.53 |
Total Medical Medicare Standardized Payment Amount |
44674.61 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
25 |
Number Of Beneficiaries Age 65 to 74 |
74 |
Number Of Beneficiaries Age 75 to 84 |
98 |
Number Of Beneficiaries Age Greater 84 |
104 |
Number Of Female Beneficiaries |
155 |
Number Of Male Beneficiaries |
146 |
Number Of Non Hispanic White Beneficiaries |
268 |
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 |
235 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
66 |
Percent Of With Atrial Fibrillation |
38 |
Percent Of With Alzheimers Disease or Dementia |
51 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
56 |
Percent Of With Chronic Kidney Disease |
68 |
Percent Of With Chronic Obstructive Pulmonary Disease |
53 |
Percent Of With Depression |
45 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
66 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
19 |
Average HCC Risk Score Of Beneficiaries |
2.9564 |