National Provider Identifier [NPI]: |
1336138197 |
Last Name Of The Provider |
MARTINEZ |
First Name Of The Provider |
SUSAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
C.R.N.A. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
17207 KUYKENDAHL RD |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
SPRING |
Zip Code Of The Provider |
773798423 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
48 |
Number Of Services |
429 |
Number Of Medicare Beneficiaries |
410 |
Total Submitted Charge Amount |
886750 |
Total Medicare Allowed Amount |
94160.55 |
Total Medicare Payment Amount |
72870.52 |
Total Medicare Standardized Payment Amount |
72840.64 |
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 |
48 |
Number Of Medical Services |
429 |
Number Of Medicare Beneficiaries With Medical Services |
410 |
Total Medical Submitted Charge Amount |
886750 |
Total Medical Medicare Allowed Amount |
94160.55 |
Total Medical Medicare Payment Amount |
72870.52 |
Total Medical Medicare Standardized Payment Amount |
72840.64 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
55 |
Number Of Beneficiaries Age 65 to 74 |
200 |
Number Of Beneficiaries Age 75 to 84 |
122 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
194 |
Number Of Male Beneficiaries |
216 |
Number Of Non Hispanic White Beneficiaries |
314 |
Number Of Black or African American Beneficiaries |
47 |
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 |
346 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
64 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
40 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.1279 |