| National Provider Identifier [NPI]: |
1003896093 |
| Last Name Of The Provider |
KONG |
| First Name Of The Provider |
XING |
| Middle Initial Of The Provider |
|
| Credentials Of The Provider |
NP |
| Gender Of The Provider |
F |
| Entity Type Of The Provider |
I |
| Street Address 1 Of The Provider |
2700 W 9TH AVE |
| Street Address 2 Of The Provider |
|
| City Of The Provider |
OSHKOSH |
| Zip Code Of The Provider |
54904 |
| State Code Of The Provider |
WI |
| Country Code Of The Provider |
US |
| Provider Type Of The Provider |
Nurse Practitioner |
| Medicare Participation Indicator |
Y |
| Number Of HCPCS |
12 |
| Number Of Services |
89 |
| Number Of Medicare Beneficiaries |
48 |
| Total Submitted Charge Amount |
13985 |
| Total Medicare Allowed Amount |
4524.16 |
| Total Medicare Payment Amount |
3401 |
| Total Medicare Standardized Payment Amount |
4179.94 |
| 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 |
12 |
| Number Of Medical Services |
89 |
| Number Of Medicare Beneficiaries With Medical Services |
48 |
| Total Medical Submitted Charge Amount |
13985 |
| Total Medical Medicare Allowed Amount |
4524.16 |
| Total Medical Medicare Payment Amount |
3401 |
| Total Medical Medicare Standardized Payment Amount |
4179.94 |
| Average Age Of Beneficiaries |
72 |
| Number Of Beneficiaries Age Less65 |
12 |
| Number Of Beneficiaries Age 65 to 74 |
17 |
| Number Of Beneficiaries Age 75 to 84 |
|
| Number Of Beneficiaries Age Greater 84 |
|
| Number Of Female Beneficiaries |
22 |
| Number Of Male Beneficiaries |
26 |
| 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 |
29 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
| Percent Of With Atrial Fibrillation |
23 |
| Percent Of With Alzheimers Disease or Dementia |
|
| Percent Of With Asthma |
|
| Percent Of With Cancer |
|
| Percent Of With Heart Failure |
35 |
| Percent Of With Chronic Kidney Disease |
50 |
| Percent Of With Chronic Obstructive Pulmonary Disease |
33 |
| Percent Of With Depression |
33 |
| Percent Of With Diabetes |
42 |
| Percent Of With Hyperlipidemia |
63 |
| Percent Of With Hypertension |
75 |
| Percent Of With Ischemic Heart Disease |
42 |
| 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 |
3.1649 |