National Provider Identifier [NPI]: |
1144381666 |
Last Name Of The Provider |
HESSEDAL |
First Name Of The Provider |
TESSA |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
ARNP |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 1ST ST SW |
Street Address 2 Of The Provider |
|
City Of The Provider |
ROCHESTER |
Zip Code Of The Provider |
559050001 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
124 |
Number Of Medicare Beneficiaries |
111 |
Total Submitted Charge Amount |
7174.24 |
Total Medicare Allowed Amount |
6285.27 |
Total Medicare Payment Amount |
3855.44 |
Total Medicare Standardized Payment Amount |
5085.81 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
11 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
392.26 |
Total Drug Medicare AllowedAmount |
392.26 |
Total Drug Medicare PaymentAmount |
384.39 |
Total Drug Medicare Standardized Payment Amount |
384.39 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
8 |
Number Of Medical Services |
113 |
Number Of Medicare Beneficiaries With Medical Services |
111 |
Total Medical Submitted Charge Amount |
6781.98 |
Total Medical Medicare Allowed Amount |
5893.01 |
Total Medical Medicare Payment Amount |
3471.05 |
Total Medical Medicare Standardized Payment Amount |
4701.42 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
44 |
Number Of Beneficiaries Age 75 to 84 |
28 |
Number Of Beneficiaries Age Greater 84 |
19 |
Number Of Female Beneficiaries |
74 |
Number Of Male Beneficiaries |
37 |
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 |
92 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
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 |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
20 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
32 |
Percent Of With Hypertension |
37 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.6932 |