National Provider Identifier [NPI]: |
1356520712 |
Last Name Of The Provider |
KETTERER |
First Name Of The Provider |
CYNTHIA |
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 |
14770 MEMORIAL DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770795252 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
140 |
Number Of Medicare Beneficiaries |
66 |
Total Submitted Charge Amount |
10444.44 |
Total Medicare Allowed Amount |
10068.67 |
Total Medicare Payment Amount |
5933.37 |
Total Medicare Standardized Payment Amount |
5913.99 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
57 |
Number Of Beneficiaries Age Less65 |
35 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
42 |
Number Of Male Beneficiaries |
24 |
Number Of Non Hispanic White Beneficiaries |
23 |
Number Of Black or African American Beneficiaries |
26 |
Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
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Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
25 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
41 |
Percent Of With Atrial Fibrillation |
0 |
Percent Of With Alzheimers Disease or Dementia |
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Percent Of With Asthma |
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Percent Of With Cancer |
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Percent Of With Heart Failure |
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Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
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Percent Of With Depression |
32 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
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Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
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Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3451 |