National Provider Identifier [NPI]: |
1003883968 |
Last Name Of The Provider |
PRESTON |
First Name Of The Provider |
REBECCA |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4479 CENTRAL AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
WESTERN SPRINGS |
Zip Code Of The Provider |
605581714 |
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 |
64 |
Number Of Services |
2124 |
Number Of Medicare Beneficiaries |
334 |
Total Submitted Charge Amount |
220020 |
Total Medicare Allowed Amount |
135653.38 |
Total Medicare Payment Amount |
99643.97 |
Total Medicare Standardized Payment Amount |
94062.95 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
164 |
Number Of Medicare Beneficiaries With Drug Services |
143 |
Total Drug Submitted ChargeAmount |
10769 |
Total Drug Medicare AllowedAmount |
6981.36 |
Total Drug Medicare PaymentAmount |
6841.09 |
Total Drug Medicare Standardized Payment Amount |
6841.09 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
55 |
Number Of Medical Services |
1960 |
Number Of Medicare Beneficiaries With Medical Services |
334 |
Total Medical Submitted Charge Amount |
209251 |
Total Medical Medicare Allowed Amount |
128672.02 |
Total Medical Medicare Payment Amount |
92802.88 |
Total Medical Medicare Standardized Payment Amount |
87221.86 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
172 |
Number Of Beneficiaries Age 75 to 84 |
82 |
Number Of Beneficiaries Age Greater 84 |
57 |
Number Of Female Beneficiaries |
229 |
Number Of Male Beneficiaries |
105 |
Number Of Non Hispanic White Beneficiaries |
310 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
311 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.0129 |