National Provider Identifier [NPI]: |
1558357830 |
Last Name Of The Provider |
WAITLEY |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
901 MCCLINTOCK DR |
Street Address 2 Of The Provider |
SUITE 201 |
City Of The Provider |
BURR RIDGE |
Zip Code Of The Provider |
605270872 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Infectious Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
15267 |
Number Of Medicare Beneficiaries |
809 |
Total Submitted Charge Amount |
600423.18 |
Total Medicare Allowed Amount |
282806.04 |
Total Medicare Payment Amount |
217704.93 |
Total Medicare Standardized Payment Amount |
206270.97 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
12665 |
Number Of Medicare Beneficiaries With Drug Services |
14 |
Total Drug Submitted ChargeAmount |
68985.18 |
Total Drug Medicare AllowedAmount |
25046.16 |
Total Drug Medicare PaymentAmount |
19663.25 |
Total Drug Medicare Standardized Payment Amount |
19663.25 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
2602 |
Number Of Medicare Beneficiaries With Medical Services |
809 |
Total Medical Submitted Charge Amount |
531438 |
Total Medical Medicare Allowed Amount |
257759.88 |
Total Medical Medicare Payment Amount |
198041.68 |
Total Medical Medicare Standardized Payment Amount |
186607.72 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
108 |
Number Of Beneficiaries Age 65 to 74 |
221 |
Number Of Beneficiaries Age 75 to 84 |
256 |
Number Of Beneficiaries Age Greater 84 |
224 |
Number Of Female Beneficiaries |
446 |
Number Of Male Beneficiaries |
363 |
Number Of Non Hispanic White Beneficiaries |
685 |
Number Of Black or African American Beneficiaries |
34 |
Number Of AsianPacific Islander Beneficiaries |
37 |
Number Of Hispanic Beneficiaries |
39 |
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 |
625 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
184 |
Percent Of With Atrial Fibrillation |
34 |
Percent Of With Alzheimers Disease or Dementia |
38 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
56 |
Percent Of With Chronic Kidney Disease |
69 |
Percent Of With Chronic Obstructive Pulmonary Disease |
39 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
55 |
Percent Of With Hyperlipidemia |
74 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
62 |
Percent Of With Osteoporosis |
20 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
65 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
3.1023 |