National Provider Identifier [NPI]: |
1982610739 |
Last Name Of The Provider |
CORNELIUS |
First Name Of The Provider |
JASON |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4225 GOLDEN VALLEY RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
GOLDEN VALLEY |
Zip Code Of The Provider |
554224215 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Neurology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
34 |
Number Of Services |
538 |
Number Of Medicare Beneficiaries |
288 |
Total Submitted Charge Amount |
270051.98 |
Total Medicare Allowed Amount |
71171.78 |
Total Medicare Payment Amount |
53290.51 |
Total Medicare Standardized Payment Amount |
54173.62 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
538 |
Number Of Medicare Beneficiaries With Medical Services |
288 |
Total Medical Submitted Charge Amount |
270051.98 |
Total Medical Medicare Allowed Amount |
71171.78 |
Total Medical Medicare Payment Amount |
53290.51 |
Total Medical Medicare Standardized Payment Amount |
54173.62 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
101 |
Number Of Beneficiaries Age 65 to 74 |
85 |
Number Of Beneficiaries Age 75 to 84 |
69 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
145 |
Number Of Male Beneficiaries |
143 |
Number Of Non Hispanic White Beneficiaries |
241 |
Number Of Black or African American Beneficiaries |
33 |
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
181 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
107 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
28 |
Average HCC Risk Score Of Beneficiaries |
1.5978 |