National Provider Identifier [NPI]: |
1871874552 |
Last Name Of The Provider |
LAWRIN |
First Name Of The Provider |
ROMAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4045 W ROYAL DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
TRAVERSE CITY |
Zip Code Of The Provider |
496848965 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
44 |
Number Of Services |
200 |
Number Of Medicare Beneficiaries |
153 |
Total Submitted Charge Amount |
88829 |
Total Medicare Allowed Amount |
27280.75 |
Total Medicare Payment Amount |
21254.67 |
Total Medicare Standardized Payment Amount |
21918.61 |
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 |
44 |
Number Of Medical Services |
200 |
Number Of Medicare Beneficiaries With Medical Services |
153 |
Total Medical Submitted Charge Amount |
88829 |
Total Medical Medicare Allowed Amount |
27280.75 |
Total Medical Medicare Payment Amount |
21254.67 |
Total Medical Medicare Standardized Payment Amount |
21918.61 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
64 |
Number Of Beneficiaries Age 75 to 84 |
48 |
Number Of Beneficiaries Age Greater 84 |
22 |
Number Of Female Beneficiaries |
94 |
Number Of Male Beneficiaries |
59 |
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 |
123 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
30 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
19 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.5009 |