National Provider Identifier [NPI]: |
1497856314 |
Last Name Of The Provider |
OLENIACZ |
First Name Of The Provider |
JONNA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2930 SQUALICUM PKWY |
Street Address 2 Of The Provider |
101 |
City Of The Provider |
BELLINGHAM |
Zip Code Of The Provider |
982251854 |
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 |
17 |
Number Of Services |
751 |
Number Of Medicare Beneficiaries |
190 |
Total Submitted Charge Amount |
96004 |
Total Medicare Allowed Amount |
24843.59 |
Total Medicare Payment Amount |
19376.89 |
Total Medicare Standardized Payment Amount |
22688.28 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
455 |
Number Of Medicare Beneficiaries With Drug Services |
62 |
Total Drug Submitted ChargeAmount |
1729 |
Total Drug Medicare AllowedAmount |
1012.11 |
Total Drug Medicare PaymentAmount |
793.4 |
Total Drug Medicare Standardized Payment Amount |
793.4 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
296 |
Number Of Medicare Beneficiaries With Medical Services |
190 |
Total Medical Submitted Charge Amount |
94275 |
Total Medical Medicare Allowed Amount |
23831.48 |
Total Medical Medicare Payment Amount |
18583.49 |
Total Medical Medicare Standardized Payment Amount |
21894.88 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
76 |
Number Of Beneficiaries Age 75 to 84 |
68 |
Number Of Beneficiaries Age Greater 84 |
19 |
Number Of Female Beneficiaries |
101 |
Number Of Male Beneficiaries |
89 |
Number Of Non Hispanic White Beneficiaries |
167 |
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 |
152 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
38 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
8 |
Percent Of With Cancer |
36 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4425 |