National Provider Identifier [NPI]: |
1578517876 |
Last Name Of The Provider |
DAVIDSON |
First Name Of The Provider |
MELISSA |
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 |
1000 JOHNSON FERRY RD NE |
Street Address 2 Of The Provider |
|
City Of The Provider |
ATLANTA |
Zip Code Of The Provider |
303421606 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
346 |
Number Of Medicare Beneficiaries |
276 |
Total Submitted Charge Amount |
149531 |
Total Medicare Allowed Amount |
32994.43 |
Total Medicare Payment Amount |
23937.42 |
Total Medicare Standardized Payment Amount |
28564.18 |
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 |
28 |
Number Of Medical Services |
346 |
Number Of Medicare Beneficiaries With Medical Services |
276 |
Total Medical Submitted Charge Amount |
149531 |
Total Medical Medicare Allowed Amount |
32994.43 |
Total Medical Medicare Payment Amount |
23937.42 |
Total Medical Medicare Standardized Payment Amount |
28564.18 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
81 |
Number Of Beneficiaries Age 65 to 74 |
100 |
Number Of Beneficiaries Age 75 to 84 |
64 |
Number Of Beneficiaries Age Greater 84 |
31 |
Number Of Female Beneficiaries |
170 |
Number Of Male Beneficiaries |
106 |
Number Of Non Hispanic White Beneficiaries |
250 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
195 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
81 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
8 |
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 |
1.6434 |