National Provider Identifier [NPI]: |
1205890381 |
Last Name Of The Provider |
KIM |
First Name Of The Provider |
ANTHONY |
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 |
1579 STRAITS TPKE |
Street Address 2 Of The Provider |
SUITE 2A |
City Of The Provider |
MIDDLEBURY |
Zip Code Of The Provider |
067621835 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
102 |
Number Of Services |
15207 |
Number Of Medicare Beneficiaries |
951 |
Total Submitted Charge Amount |
1167886.3 |
Total Medicare Allowed Amount |
592589.52 |
Total Medicare Payment Amount |
451252.11 |
Total Medicare Standardized Payment Amount |
432252.31 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
9820 |
Number Of Medicare Beneficiaries With Drug Services |
127 |
Total Drug Submitted ChargeAmount |
342803.8 |
Total Drug Medicare AllowedAmount |
224115.93 |
Total Drug Medicare PaymentAmount |
175363.75 |
Total Drug Medicare Standardized Payment Amount |
175363.75 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
88 |
Number Of Medical Services |
5387 |
Number Of Medicare Beneficiaries With Medical Services |
950 |
Total Medical Submitted Charge Amount |
825082.5 |
Total Medical Medicare Allowed Amount |
368473.59 |
Total Medical Medicare Payment Amount |
275888.36 |
Total Medical Medicare Standardized Payment Amount |
256888.56 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
120 |
Number Of Beneficiaries Age 65 to 74 |
356 |
Number Of Beneficiaries Age 75 to 84 |
312 |
Number Of Beneficiaries Age Greater 84 |
163 |
Number Of Female Beneficiaries |
285 |
Number Of Male Beneficiaries |
666 |
Number Of Non Hispanic White Beneficiaries |
801 |
Number Of Black or African American Beneficiaries |
63 |
Number Of AsianPacific Islander Beneficiaries |
14 |
Number Of Hispanic Beneficiaries |
59 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
14 |
Number Of Beneficiaries With Medicare Only Entitlement |
693 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
258 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
21 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
73 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.4509 |