National Provider Identifier [NPI]: |
1174838536 |
Last Name Of The Provider |
CASE |
First Name Of The Provider |
TRISTEN |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3300 GALLOWS RD |
Street Address 2 Of The Provider |
FAIRFAX INOVA HOSPITAL |
City Of The Provider |
FALLS CHURCH |
Zip Code Of The Provider |
220423307 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
958 |
Number Of Medicare Beneficiaries |
201 |
Total Submitted Charge Amount |
100449 |
Total Medicare Allowed Amount |
18656.27 |
Total Medicare Payment Amount |
14628.2 |
Total Medicare Standardized Payment Amount |
19538.75 |
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 |
11 |
Number Of Medical Services |
958 |
Number Of Medicare Beneficiaries With Medical Services |
201 |
Total Medical Submitted Charge Amount |
100449 |
Total Medical Medicare Allowed Amount |
18656.27 |
Total Medical Medicare Payment Amount |
14628.2 |
Total Medical Medicare Standardized Payment Amount |
19538.75 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
21 |
Number Of Beneficiaries Age 65 to 74 |
69 |
Number Of Beneficiaries Age 75 to 84 |
57 |
Number Of Beneficiaries Age Greater 84 |
54 |
Number Of Female Beneficiaries |
94 |
Number Of Male Beneficiaries |
107 |
Number Of Non Hispanic White Beneficiaries |
168 |
Number Of Black or African American Beneficiaries |
18 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
176 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
25 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
42 |
Percent Of With Chronic Kidney Disease |
46 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
57 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
2.4854 |