National Provider Identifier [NPI]: |
1760709851 |
Last Name Of The Provider |
DAILY |
First Name Of The Provider |
TAMERA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
APN |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8940 N WOOD SAGE RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
PEORIA |
Zip Code Of The Provider |
616157822 |
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 |
78 |
Number Of Services |
20764 |
Number Of Medicare Beneficiaries |
204 |
Total Submitted Charge Amount |
869331 |
Total Medicare Allowed Amount |
275095.87 |
Total Medicare Payment Amount |
215042 |
Total Medicare Standardized Payment Amount |
219845.9 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
51 |
Number Of Drug Services |
20134 |
Number Of Medicare Beneficiaries With Drug Services |
74 |
Total Drug Submitted ChargeAmount |
735237 |
Total Drug Medicare AllowedAmount |
244426.2 |
Total Drug Medicare PaymentAmount |
191573.15 |
Total Drug Medicare Standardized Payment Amount |
191573.15 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
630 |
Number Of Medicare Beneficiaries With Medical Services |
204 |
Total Medical Submitted Charge Amount |
134094 |
Total Medical Medicare Allowed Amount |
30669.67 |
Total Medical Medicare Payment Amount |
23468.85 |
Total Medical Medicare Standardized Payment Amount |
28272.75 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
83 |
Number Of Beneficiaries Age 75 to 84 |
62 |
Number Of Beneficiaries Age Greater 84 |
36 |
Number Of Female Beneficiaries |
128 |
Number Of Male Beneficiaries |
76 |
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 |
160 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
44 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
|
Percent Of With Cancer |
48 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
41 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.0541 |