National Provider Identifier [NPI]: |
1629077193 |
Last Name Of The Provider |
HENRY |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4320 SEMINARY RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
ALEXANDRIA |
Zip Code Of The Provider |
223041535 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
38 |
Number Of Services |
453 |
Number Of Medicare Beneficiaries |
362 |
Total Submitted Charge Amount |
317903.6 |
Total Medicare Allowed Amount |
89398.72 |
Total Medicare Payment Amount |
68853.11 |
Total Medicare Standardized Payment Amount |
63384.34 |
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 |
38 |
Number Of Medical Services |
453 |
Number Of Medicare Beneficiaries With Medical Services |
362 |
Total Medical Submitted Charge Amount |
317903.6 |
Total Medical Medicare Allowed Amount |
89398.72 |
Total Medical Medicare Payment Amount |
68853.11 |
Total Medical Medicare Standardized Payment Amount |
63384.34 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
108 |
Number Of Beneficiaries Age 65 to 74 |
132 |
Number Of Beneficiaries Age 75 to 84 |
92 |
Number Of Beneficiaries Age Greater 84 |
30 |
Number Of Female Beneficiaries |
183 |
Number Of Male Beneficiaries |
179 |
Number Of Non Hispanic White Beneficiaries |
171 |
Number Of Black or African American Beneficiaries |
131 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
33 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
247 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
115 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
65 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
53 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
5.0543 |