National Provider Identifier [NPI]: |
1447556543 |
Last Name Of The Provider |
EVANS |
First Name Of The Provider |
ERIN |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
N.P. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
50 S WASHINGTON ST |
Street Address 2 Of The Provider |
STE. 302 |
City Of The Provider |
HINSDALE |
Zip Code Of The Provider |
605214138 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nurse Practitioner |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
124 |
Number Of Medicare Beneficiaries |
65 |
Total Submitted Charge Amount |
4393.63 |
Total Medicare Allowed Amount |
3990.87 |
Total Medicare Payment Amount |
3100.1 |
Total Medicare Standardized Payment Amount |
4120.63 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
42 |
Number Of Medicare Beneficiaries With Drug Services |
40 |
Total Drug Submitted ChargeAmount |
1658.63 |
Total Drug Medicare AllowedAmount |
1452.8 |
Total Drug Medicare PaymentAmount |
1423.66 |
Total Drug Medicare Standardized Payment Amount |
1423.66 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
82 |
Number Of Medicare Beneficiaries With Medical Services |
64 |
Total Medical Submitted Charge Amount |
2735 |
Total Medical Medicare Allowed Amount |
2538.07 |
Total Medical Medicare Payment Amount |
1676.44 |
Total Medical Medicare Standardized Payment Amount |
2696.97 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
47 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
43 |
Number Of Male Beneficiaries |
22 |
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 |
65 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
0 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
0 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.6487 |