National Provider Identifier [NPI]: |
1952349136 |
Last Name Of The Provider |
JOSEPHSON |
First Name Of The Provider |
AMY |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1615 DELAWARE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
LONGVIEW |
Zip Code Of The Provider |
986322367 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
208 |
Number Of Medicare Beneficiaries |
175 |
Total Submitted Charge Amount |
62446 |
Total Medicare Allowed Amount |
14759.42 |
Total Medicare Payment Amount |
10811.6 |
Total Medicare Standardized Payment Amount |
13076.96 |
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 |
208 |
Number Of Medicare Beneficiaries With Medical Services |
175 |
Total Medical Submitted Charge Amount |
62446 |
Total Medical Medicare Allowed Amount |
14759.42 |
Total Medical Medicare Payment Amount |
10811.6 |
Total Medical Medicare Standardized Payment Amount |
13076.96 |
Average Age Of Beneficiaries |
57 |
Number Of Beneficiaries Age Less65 |
107 |
Number Of Beneficiaries Age 65 to 74 |
41 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
111 |
Number Of Male Beneficiaries |
64 |
Number Of Non Hispanic White Beneficiaries |
148 |
Number Of Black or African American Beneficiaries |
14 |
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 |
47 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
128 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
30 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3413 |