National Provider Identifier [NPI]: |
1407864531 |
Last Name Of The Provider |
KHOURI |
First Name Of The Provider |
DANIEL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1200 W WALL ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
MIDLAND |
Zip Code Of The Provider |
797016620 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
43 |
Number Of Services |
4063 |
Number Of Medicare Beneficiaries |
381 |
Total Submitted Charge Amount |
1390254 |
Total Medicare Allowed Amount |
287443 |
Total Medicare Payment Amount |
222420.19 |
Total Medicare Standardized Payment Amount |
233202.02 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
181 |
Number Of Medicare Beneficiaries With Drug Services |
19 |
Total Drug Submitted ChargeAmount |
348000 |
Total Drug Medicare AllowedAmount |
39623.55 |
Total Drug Medicare PaymentAmount |
31016.24 |
Total Drug Medicare Standardized Payment Amount |
31016.24 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
42 |
Number Of Medical Services |
3882 |
Number Of Medicare Beneficiaries With Medical Services |
381 |
Total Medical Submitted Charge Amount |
1042254 |
Total Medical Medicare Allowed Amount |
247819.45 |
Total Medical Medicare Payment Amount |
191403.95 |
Total Medical Medicare Standardized Payment Amount |
202185.78 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
51 |
Number Of Beneficiaries Age 65 to 74 |
134 |
Number Of Beneficiaries Age 75 to 84 |
137 |
Number Of Beneficiaries Age Greater 84 |
59 |
Number Of Female Beneficiaries |
92 |
Number Of Male Beneficiaries |
289 |
Number Of Non Hispanic White Beneficiaries |
210 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
137 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
275 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
106 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.1382 |