National Provider Identifier [NPI]: |
1982762688 |
Last Name Of The Provider |
SHEVLIN |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
PA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2929 HEALTH CENTER DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921232762 |
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 |
4 |
Number Of Services |
210 |
Number Of Medicare Beneficiaries |
105 |
Total Submitted Charge Amount |
5043 |
Total Medicare Allowed Amount |
3506.35 |
Total Medicare Payment Amount |
3436.42 |
Total Medicare Standardized Payment Amount |
4062.22 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
105 |
Number Of Medicare Beneficiaries With Drug Services |
105 |
Total Drug Submitted ChargeAmount |
3048 |
Total Drug Medicare AllowedAmount |
1511.35 |
Total Drug Medicare PaymentAmount |
1481.32 |
Total Drug Medicare Standardized Payment Amount |
1481.32 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
1 |
Number Of Medical Services |
105 |
Number Of Medicare Beneficiaries With Medical Services |
105 |
Total Medical Submitted Charge Amount |
1995 |
Total Medical Medicare Allowed Amount |
1995 |
Total Medical Medicare Payment Amount |
1955.1 |
Total Medical Medicare Standardized Payment Amount |
2580.9 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
56 |
Number Of Beneficiaries Age 75 to 84 |
33 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
53 |
Number Of Male Beneficiaries |
52 |
Number Of Non Hispanic White Beneficiaries |
54 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
28 |
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 |
91 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
|
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 |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
25 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7868 |