National Provider Identifier [NPI]: |
1942448733 |
Last Name Of The Provider |
VANOPSTAL |
First Name Of The Provider |
ALAN |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3054 S LYMAN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606085534 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
1132 |
Number Of Medicare Beneficiaries |
1021 |
Total Submitted Charge Amount |
435097 |
Total Medicare Allowed Amount |
167762.25 |
Total Medicare Payment Amount |
123090.93 |
Total Medicare Standardized Payment Amount |
113406.79 |
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 |
28 |
Number Of Medical Services |
1132 |
Number Of Medicare Beneficiaries With Medical Services |
1021 |
Total Medical Submitted Charge Amount |
435097 |
Total Medical Medicare Allowed Amount |
167762.25 |
Total Medical Medicare Payment Amount |
123090.93 |
Total Medical Medicare Standardized Payment Amount |
113406.79 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
122 |
Number Of Beneficiaries Age 65 to 74 |
272 |
Number Of Beneficiaries Age 75 to 84 |
297 |
Number Of Beneficiaries Age Greater 84 |
330 |
Number Of Female Beneficiaries |
582 |
Number Of Male Beneficiaries |
439 |
Number Of Non Hispanic White Beneficiaries |
860 |
Number Of Black or African American Beneficiaries |
66 |
Number Of AsianPacific Islander Beneficiaries |
38 |
Number Of Hispanic Beneficiaries |
36 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
21 |
Number Of Beneficiaries With Medicare Only Entitlement |
776 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
245 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.8688 |