National Provider Identifier [NPI]: |
1982663043 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
BERNARD |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3809 DARROW RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
STOW |
Zip Code Of The Provider |
442244035 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
18 |
Number Of Services |
423 |
Number Of Medicare Beneficiaries |
82 |
Total Submitted Charge Amount |
49103 |
Total Medicare Allowed Amount |
42650.78 |
Total Medicare Payment Amount |
28459.1 |
Total Medicare Standardized Payment Amount |
30747.08 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
30 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
940 |
Total Drug Medicare AllowedAmount |
395.71 |
Total Drug Medicare PaymentAmount |
369.54 |
Total Drug Medicare Standardized Payment Amount |
369.54 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
13 |
Number Of Medical Services |
393 |
Number Of Medicare Beneficiaries With Medical Services |
82 |
Total Medical Submitted Charge Amount |
48163 |
Total Medical Medicare Allowed Amount |
42255.07 |
Total Medical Medicare Payment Amount |
28089.56 |
Total Medical Medicare Standardized Payment Amount |
30377.54 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
31 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
40 |
Number Of Male Beneficiaries |
42 |
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 |
68 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
13 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
59 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0777 |