National Provider Identifier [NPI]: |
1174590889 |
Last Name Of The Provider |
WEGMAN |
First Name Of The Provider |
CHERYL |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
30456 GRANDVIEW TER |
Street Address 2 Of The Provider |
|
City Of The Provider |
MACKINAW |
Zip Code Of The Provider |
617559359 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
297 |
Number Of Medicare Beneficiaries |
119 |
Total Submitted Charge Amount |
22078 |
Total Medicare Allowed Amount |
12538.72 |
Total Medicare Payment Amount |
7716.8 |
Total Medicare Standardized Payment Amount |
8198.72 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
25 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
959 |
Total Drug Medicare AllowedAmount |
419.89 |
Total Drug Medicare PaymentAmount |
367.14 |
Total Drug Medicare Standardized Payment Amount |
367.14 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
272 |
Number Of Medicare Beneficiaries With Medical Services |
119 |
Total Medical Submitted Charge Amount |
21119 |
Total Medical Medicare Allowed Amount |
12118.83 |
Total Medical Medicare Payment Amount |
7349.66 |
Total Medical Medicare Standardized Payment Amount |
7831.58 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
11 |
Number Of Beneficiaries Age 65 to 74 |
46 |
Number Of Beneficiaries Age 75 to 84 |
40 |
Number Of Beneficiaries Age Greater 84 |
22 |
Number Of Female Beneficiaries |
77 |
Number Of Male Beneficiaries |
42 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9622 |