National Provider Identifier [NPI]: |
1487738084 |
Last Name Of The Provider |
KWA |
First Name Of The Provider |
ENG-HWI |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
80 BRIDGE ST |
Street Address 2 Of The Provider |
SUITE 106 |
City Of The Provider |
DEDHAM |
Zip Code Of The Provider |
020261765 |
State Code Of The Provider |
MA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
13 |
Number Of Services |
374 |
Number Of Medicare Beneficiaries |
98 |
Total Submitted Charge Amount |
41369 |
Total Medicare Allowed Amount |
23986.88 |
Total Medicare Payment Amount |
16037.86 |
Total Medicare Standardized Payment Amount |
14853.75 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
27 |
Number Of Medicare Beneficiaries With Drug Services |
26 |
Total Drug Submitted ChargeAmount |
940 |
Total Drug Medicare AllowedAmount |
356.33 |
Total Drug Medicare PaymentAmount |
344.92 |
Total Drug Medicare Standardized Payment Amount |
344.92 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
10 |
Number Of Medical Services |
347 |
Number Of Medicare Beneficiaries With Medical Services |
98 |
Total Medical Submitted Charge Amount |
40429 |
Total Medical Medicare Allowed Amount |
23630.55 |
Total Medical Medicare Payment Amount |
15692.94 |
Total Medical Medicare Standardized Payment Amount |
14508.83 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
39 |
Number Of Beneficiaries Age 75 to 84 |
33 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
54 |
Number Of Male Beneficiaries |
44 |
Number Of Non Hispanic White Beneficiaries |
72 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
12 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
80 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
20 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9671 |