National Provider Identifier [NPI]: |
1528041787 |
Last Name Of The Provider |
WOODFORD |
First Name Of The Provider |
CLIFTON |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2414 KOHLER MEMORIAL DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SHEBOYGAN |
Zip Code Of The Provider |
530813129 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
54 |
Number Of Services |
783 |
Number Of Medicare Beneficiaries |
406 |
Total Submitted Charge Amount |
151879 |
Total Medicare Allowed Amount |
47934.98 |
Total Medicare Payment Amount |
32923.01 |
Total Medicare Standardized Payment Amount |
34627.95 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
37 |
Number Of Medicare Beneficiaries With Drug Services |
24 |
Total Drug Submitted ChargeAmount |
945 |
Total Drug Medicare AllowedAmount |
229.05 |
Total Drug Medicare PaymentAmount |
179.45 |
Total Drug Medicare Standardized Payment Amount |
179.45 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
46 |
Number Of Medical Services |
746 |
Number Of Medicare Beneficiaries With Medical Services |
406 |
Total Medical Submitted Charge Amount |
150934 |
Total Medical Medicare Allowed Amount |
47705.93 |
Total Medical Medicare Payment Amount |
32743.56 |
Total Medical Medicare Standardized Payment Amount |
34448.5 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
121 |
Number Of Beneficiaries Age 65 to 74 |
160 |
Number Of Beneficiaries Age 75 to 84 |
77 |
Number Of Beneficiaries Age Greater 84 |
48 |
Number Of Female Beneficiaries |
226 |
Number Of Male Beneficiaries |
180 |
Number Of Non Hispanic White Beneficiaries |
373 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
12 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
292 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
114 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9788 |