National Provider Identifier [NPI]: |
1245461516 |
Last Name Of The Provider |
TOLSON |
First Name Of The Provider |
MELANIE |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
PA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
10590 N MERIDIAN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462901028 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
434 |
Number Of Medicare Beneficiaries |
266 |
Total Submitted Charge Amount |
78065 |
Total Medicare Allowed Amount |
34222.96 |
Total Medicare Payment Amount |
26193.93 |
Total Medicare Standardized Payment Amount |
32787.07 |
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 |
11 |
Number Of Medical Services |
434 |
Number Of Medicare Beneficiaries With Medical Services |
266 |
Total Medical Submitted Charge Amount |
78065 |
Total Medical Medicare Allowed Amount |
34222.96 |
Total Medical Medicare Payment Amount |
26193.93 |
Total Medical Medicare Standardized Payment Amount |
32787.07 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
104 |
Number Of Beneficiaries Age 75 to 84 |
92 |
Number Of Beneficiaries Age Greater 84 |
44 |
Number Of Female Beneficiaries |
120 |
Number Of Male Beneficiaries |
146 |
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 |
234 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
32 |
Percent Of With Atrial Fibrillation |
39 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
68 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
40 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.6985 |