National Provider Identifier [NPI]: |
1376756080 |
Last Name Of The Provider |
MORGAN |
First Name Of The Provider |
FANTA |
Middle Initial Of The Provider |
V |
Credentials Of The Provider |
D.P.M. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
22 OLD RUDNICK LN |
Street Address 2 Of The Provider |
|
City Of The Provider |
DOVER |
Zip Code Of The Provider |
199014912 |
State Code Of The Provider |
DE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Podiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
50 |
Number Of Services |
4443 |
Number Of Medicare Beneficiaries |
931 |
Total Submitted Charge Amount |
247105.11 |
Total Medicare Allowed Amount |
206281.67 |
Total Medicare Payment Amount |
151028.21 |
Total Medicare Standardized Payment Amount |
148491.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
55 |
Number Of Medicare Beneficiaries With Drug Services |
34 |
Total Drug Submitted ChargeAmount |
550 |
Total Drug Medicare AllowedAmount |
167.54 |
Total Drug Medicare PaymentAmount |
129.21 |
Total Drug Medicare Standardized Payment Amount |
129.21 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
49 |
Number Of Medical Services |
4388 |
Number Of Medicare Beneficiaries With Medical Services |
931 |
Total Medical Submitted Charge Amount |
246555.11 |
Total Medical Medicare Allowed Amount |
206114.13 |
Total Medical Medicare Payment Amount |
150899 |
Total Medical Medicare Standardized Payment Amount |
148361.94 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
136 |
Number Of Beneficiaries Age 65 to 74 |
307 |
Number Of Beneficiaries Age 75 to 84 |
282 |
Number Of Beneficiaries Age Greater 84 |
206 |
Number Of Female Beneficiaries |
598 |
Number Of Male Beneficiaries |
333 |
Number Of Non Hispanic White Beneficiaries |
573 |
Number Of Black or African American Beneficiaries |
326 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
19 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
681 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
250 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.6996 |