National Provider Identifier [NPI]: |
1568579407 |
Last Name Of The Provider |
SOMMERVILLE |
First Name Of The Provider |
DREW |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
201 W IOWA ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
EVANSVILLE |
Zip Code Of The Provider |
477101721 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
19364 |
Number Of Medicare Beneficiaries |
1663 |
Total Submitted Charge Amount |
6737985.71 |
Total Medicare Allowed Amount |
2256703.72 |
Total Medicare Payment Amount |
1712921.71 |
Total Medicare Standardized Payment Amount |
1771061.63 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
7040 |
Number Of Medicare Beneficiaries With Drug Services |
215 |
Total Drug Submitted ChargeAmount |
2042725.71 |
Total Drug Medicare AllowedAmount |
1026728.2 |
Total Drug Medicare PaymentAmount |
802325.15 |
Total Drug Medicare Standardized Payment Amount |
802325.15 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
47 |
Number Of Medical Services |
12324 |
Number Of Medicare Beneficiaries With Medical Services |
1663 |
Total Medical Submitted Charge Amount |
4695260 |
Total Medical Medicare Allowed Amount |
1229975.52 |
Total Medical Medicare Payment Amount |
910596.56 |
Total Medical Medicare Standardized Payment Amount |
968736.48 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
129 |
Number Of Beneficiaries Age 65 to 74 |
610 |
Number Of Beneficiaries Age 75 to 84 |
565 |
Number Of Beneficiaries Age Greater 84 |
359 |
Number Of Female Beneficiaries |
930 |
Number Of Male Beneficiaries |
733 |
Number Of Non Hispanic White Beneficiaries |
1615 |
Number Of Black or African American Beneficiaries |
24 |
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 |
12 |
Number Of Beneficiaries With Medicare Only Entitlement |
1464 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
199 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.3035 |