National Provider Identifier [NPI]: |
1952306920 |
Last Name Of The Provider |
ELLES |
First Name Of The Provider |
PATRICIA |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
CRNA |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2411 FOUNTAIN VIEW DR |
Street Address 2 Of The Provider |
STE. 200 |
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770574817 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
4 |
Number Of Services |
833 |
Number Of Medicare Beneficiaries |
562 |
Total Submitted Charge Amount |
314580 |
Total Medicare Allowed Amount |
96112.73 |
Total Medicare Payment Amount |
71675.89 |
Total Medicare Standardized Payment Amount |
72354.42 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
4 |
Number Of Medical Services |
833 |
Number Of Medicare Beneficiaries With Medical Services |
562 |
Total Medical Submitted Charge Amount |
314580 |
Total Medical Medicare Allowed Amount |
96112.73 |
Total Medical Medicare Payment Amount |
71675.89 |
Total Medical Medicare Standardized Payment Amount |
72354.42 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
325 |
Number Of Beneficiaries Age 75 to 84 |
182 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
327 |
Number Of Male Beneficiaries |
235 |
Number Of Non Hispanic White Beneficiaries |
448 |
Number Of Black or African American Beneficiaries |
54 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
44 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
523 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
39 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.0496 |