National Provider Identifier [NPI]: |
1881995983 |
Last Name Of The Provider |
KORNIYENKO |
First Name Of The Provider |
ALEKSANDR |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2608 MCDONALD RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
TYLER |
Zip Code Of The Provider |
757015934 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
648 |
Number Of Medicare Beneficiaries |
416 |
Total Submitted Charge Amount |
114667 |
Total Medicare Allowed Amount |
66025.58 |
Total Medicare Payment Amount |
50936.06 |
Total Medicare Standardized Payment Amount |
48277.43 |
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 |
14 |
Number Of Medical Services |
648 |
Number Of Medicare Beneficiaries With Medical Services |
416 |
Total Medical Submitted Charge Amount |
114667 |
Total Medical Medicare Allowed Amount |
66025.58 |
Total Medical Medicare Payment Amount |
50936.06 |
Total Medical Medicare Standardized Payment Amount |
48277.43 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
68 |
Number Of Beneficiaries Age 65 to 74 |
92 |
Number Of Beneficiaries Age 75 to 84 |
103 |
Number Of Beneficiaries Age Greater 84 |
153 |
Number Of Female Beneficiaries |
262 |
Number Of Male Beneficiaries |
154 |
Number Of Non Hispanic White Beneficiaries |
360 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
25 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
225 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
191 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
34 |
Percent Of With Asthma |
20 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
60 |
Percent Of With Chronic Obstructive Pulmonary Disease |
34 |
Percent Of With Depression |
45 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
69 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.521 |