National Provider Identifier [NPI]: |
1114989381 |
Last Name Of The Provider |
LOCKHART |
First Name Of The Provider |
ROXANNE |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8675 VALLEY CREEK RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
WOODBURY |
Zip Code Of The Provider |
551252337 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
60 |
Number Of Services |
579 |
Number Of Medicare Beneficiaries |
111 |
Total Submitted Charge Amount |
32611 |
Total Medicare Allowed Amount |
12648.18 |
Total Medicare Payment Amount |
9794.14 |
Total Medicare Standardized Payment Amount |
9858.86 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
14 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
695 |
Total Drug Medicare AllowedAmount |
400.11 |
Total Drug Medicare PaymentAmount |
370.58 |
Total Drug Medicare Standardized Payment Amount |
370.58 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
56 |
Number Of Medical Services |
565 |
Number Of Medicare Beneficiaries With Medical Services |
111 |
Total Medical Submitted Charge Amount |
31916 |
Total Medical Medicare Allowed Amount |
12248.07 |
Total Medical Medicare Payment Amount |
9423.56 |
Total Medical Medicare Standardized Payment Amount |
9488.28 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
44 |
Number Of Beneficiaries Age 75 to 84 |
25 |
Number Of Beneficiaries Age Greater 84 |
11 |
Number Of Female Beneficiaries |
72 |
Number Of Male Beneficiaries |
39 |
Number Of Non Hispanic White Beneficiaries |
100 |
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 |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
87 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
24 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
10 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
31 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
24 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.169 |