National Provider Identifier [NPI]: |
1245678424 |
Last Name Of The Provider |
LEMERT |
First Name Of The Provider |
SARA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1245 WILSHIRE BLVD |
Street Address 2 Of The Provider |
SUITE 606 |
City Of The Provider |
LOS ANGELES |
Zip Code Of The Provider |
900174810 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
103 |
Number Of Medicare Beneficiaries |
70 |
Total Submitted Charge Amount |
556010.4 |
Total Medicare Allowed Amount |
15483.98 |
Total Medicare Payment Amount |
12139.41 |
Total Medicare Standardized Payment Amount |
11687.64 |
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 |
36 |
Number Of Medical Services |
103 |
Number Of Medicare Beneficiaries With Medical Services |
70 |
Total Medical Submitted Charge Amount |
556010.4 |
Total Medical Medicare Allowed Amount |
15483.98 |
Total Medical Medicare Payment Amount |
12139.41 |
Total Medical Medicare Standardized Payment Amount |
11687.64 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
24 |
Number Of Beneficiaries Age Greater 84 |
23 |
Number Of Female Beneficiaries |
23 |
Number Of Male Beneficiaries |
47 |
Number Of Non Hispanic White Beneficiaries |
36 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
19 |
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 |
41 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
29 |
Percent Of With Atrial Fibrillation |
41 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
75 |
Percent Of With Chronic Kidney Disease |
59 |
Percent Of With Chronic Obstructive Pulmonary Disease |
41 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
63 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
19 |
Average HCC Risk Score Of Beneficiaries |
3.2554 |