National Provider Identifier [NPI]: |
1790872158 |
Last Name Of The Provider |
ALLEN |
First Name Of The Provider |
RENAI |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
NP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
39 SPRUCE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
WATERTOWN |
Zip Code Of The Provider |
024721902 |
State Code Of The Provider |
MA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
244 |
Number Of Medicare Beneficiaries |
78 |
Total Submitted Charge Amount |
9596.39 |
Total Medicare Allowed Amount |
8469.3 |
Total Medicare Payment Amount |
5973.5 |
Total Medicare Standardized Payment Amount |
7040.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
141 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
3547.99 |
Total Drug Medicare AllowedAmount |
3306.73 |
Total Drug Medicare PaymentAmount |
2743.13 |
Total Drug Medicare Standardized Payment Amount |
2743.13 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
17 |
Number Of Medical Services |
103 |
Number Of Medicare Beneficiaries With Medical Services |
78 |
Total Medical Submitted Charge Amount |
6048.4 |
Total Medical Medicare Allowed Amount |
5162.57 |
Total Medical Medicare Payment Amount |
3230.37 |
Total Medical Medicare Standardized Payment Amount |
4297.57 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
49 |
Number Of Beneficiaries Age 75 to 84 |
17 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
48 |
Number Of Male Beneficiaries |
30 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7131 |