National Provider Identifier [NPI]: |
1083737969 |
Last Name Of The Provider |
MIEDEMA |
First Name Of The Provider |
JILL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
382 120TH AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOLLAND |
Zip Code Of The Provider |
494242169 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
59 |
Number Of Services |
585 |
Number Of Medicare Beneficiaries |
134 |
Total Submitted Charge Amount |
46082 |
Total Medicare Allowed Amount |
32838.71 |
Total Medicare Payment Amount |
23935.9 |
Total Medicare Standardized Payment Amount |
25570.65 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
89 |
Number Of Medicare Beneficiaries With Drug Services |
52 |
Total Drug Submitted ChargeAmount |
1610 |
Total Drug Medicare AllowedAmount |
1244.01 |
Total Drug Medicare PaymentAmount |
1209.31 |
Total Drug Medicare Standardized Payment Amount |
1209.31 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
48 |
Number Of Medical Services |
496 |
Number Of Medicare Beneficiaries With Medical Services |
134 |
Total Medical Submitted Charge Amount |
44472 |
Total Medical Medicare Allowed Amount |
31594.7 |
Total Medical Medicare Payment Amount |
22726.59 |
Total Medical Medicare Standardized Payment Amount |
24361.34 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
41 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
92 |
Number Of Male Beneficiaries |
42 |
Number Of Non Hispanic White Beneficiaries |
111 |
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 |
93 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
41 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
8 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
41 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
18 |
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 |
1.0706 |