National Provider Identifier [NPI]: |
1144300666 |
Last Name Of The Provider |
COLES |
First Name Of The Provider |
CHESTER |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5937 GOODWOOD AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
BATON ROUGE |
Zip Code Of The Provider |
708067308 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
7 |
Number Of Services |
827 |
Number Of Medicare Beneficiaries |
397 |
Total Submitted Charge Amount |
118975 |
Total Medicare Allowed Amount |
56113.57 |
Total Medicare Payment Amount |
52705.7 |
Total Medicare Standardized Payment Amount |
58577.51 |
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 |
7 |
Number Of Medical Services |
827 |
Number Of Medicare Beneficiaries With Medical Services |
397 |
Total Medical Submitted Charge Amount |
118975 |
Total Medical Medicare Allowed Amount |
56113.57 |
Total Medical Medicare Payment Amount |
52705.7 |
Total Medical Medicare Standardized Payment Amount |
58577.51 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
256 |
Number Of Beneficiaries Age 75 to 84 |
91 |
Number Of Beneficiaries Age Greater 84 |
13 |
Number Of Female Beneficiaries |
|
Number Of Male Beneficiaries |
|
Number Of Non Hispanic White Beneficiaries |
351 |
Number Of Black or African American Beneficiaries |
33 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
365 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
32 |
Percent Of With Atrial Fibrillation |
3 |
Percent Of With Alzheimers Disease or Dementia |
3 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
6 |
Percent Of With Chronic Kidney Disease |
6 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7084 |