National Provider Identifier [NPI]: |
1942392675 |
Last Name Of The Provider |
COLE |
First Name Of The Provider |
BRADLEY |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
APRN,NP-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2406 EAST EMPIRE |
Street Address 2 Of The Provider |
|
City Of The Provider |
BLOOMINGTON |
Zip Code Of The Provider |
61704 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
58 |
Number Of Services |
1039 |
Number Of Medicare Beneficiaries |
177 |
Total Submitted Charge Amount |
283340 |
Total Medicare Allowed Amount |
50106.97 |
Total Medicare Payment Amount |
36288.04 |
Total Medicare Standardized Payment Amount |
41822.53 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
444 |
Number Of Medicare Beneficiaries With Drug Services |
89 |
Total Drug Submitted ChargeAmount |
46725 |
Total Drug Medicare AllowedAmount |
19437.79 |
Total Drug Medicare PaymentAmount |
14882.63 |
Total Drug Medicare Standardized Payment Amount |
14882.63 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
54 |
Number Of Medical Services |
595 |
Number Of Medicare Beneficiaries With Medical Services |
177 |
Total Medical Submitted Charge Amount |
236615 |
Total Medical Medicare Allowed Amount |
30669.18 |
Total Medical Medicare Payment Amount |
21405.41 |
Total Medical Medicare Standardized Payment Amount |
26939.9 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
14 |
Number Of Beneficiaries Age 65 to 74 |
84 |
Number Of Beneficiaries Age 75 to 84 |
53 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
114 |
Number Of Male Beneficiaries |
63 |
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 |
162 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
15 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
18 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9909 |