National Provider Identifier [NPI]: |
1841252426 |
Last Name Of The Provider |
POOLE |
First Name Of The Provider |
LAUREL |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1124 ESSINGTON RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
JOLIET |
Zip Code Of The Provider |
604358423 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
2558 |
Number Of Medicare Beneficiaries |
553 |
Total Submitted Charge Amount |
150141.67 |
Total Medicare Allowed Amount |
110451.94 |
Total Medicare Payment Amount |
76658.72 |
Total Medicare Standardized Payment Amount |
88523.87 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
58 |
Number Of Medicare Beneficiaries With Drug Services |
19 |
Total Drug Submitted ChargeAmount |
464 |
Total Drug Medicare AllowedAmount |
103.6 |
Total Drug Medicare PaymentAmount |
81.22 |
Total Drug Medicare Standardized Payment Amount |
81.22 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
2500 |
Number Of Medicare Beneficiaries With Medical Services |
553 |
Total Medical Submitted Charge Amount |
149677.67 |
Total Medical Medicare Allowed Amount |
110348.34 |
Total Medical Medicare Payment Amount |
76577.5 |
Total Medical Medicare Standardized Payment Amount |
88442.65 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
43 |
Number Of Beneficiaries Age 65 to 74 |
277 |
Number Of Beneficiaries Age 75 to 84 |
165 |
Number Of Beneficiaries Age Greater 84 |
68 |
Number Of Female Beneficiaries |
314 |
Number Of Male Beneficiaries |
239 |
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 |
514 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
39 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9155 |