National Provider Identifier [NPI]: |
1407895121 |
Last Name Of The Provider |
GLYNN |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
676 N SAINT CLAIR ST |
Street Address 2 Of The Provider |
SUITE 415 |
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606112927 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
32 |
Number Of Services |
1804 |
Number Of Medicare Beneficiaries |
327 |
Total Submitted Charge Amount |
233889 |
Total Medicare Allowed Amount |
109974.89 |
Total Medicare Payment Amount |
81580.08 |
Total Medicare Standardized Payment Amount |
77929.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
154 |
Number Of Medicare Beneficiaries With Drug Services |
113 |
Total Drug Submitted ChargeAmount |
16950 |
Total Drug Medicare AllowedAmount |
7687.5 |
Total Drug Medicare PaymentAmount |
7523.51 |
Total Drug Medicare Standardized Payment Amount |
7523.51 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
1650 |
Number Of Medicare Beneficiaries With Medical Services |
327 |
Total Medical Submitted Charge Amount |
216939 |
Total Medical Medicare Allowed Amount |
102287.39 |
Total Medical Medicare Payment Amount |
74056.57 |
Total Medical Medicare Standardized Payment Amount |
70406.47 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
15 |
Number Of Beneficiaries Age 65 to 74 |
181 |
Number Of Beneficiaries Age 75 to 84 |
98 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
147 |
Number Of Male Beneficiaries |
180 |
Number Of Non Hispanic White Beneficiaries |
230 |
Number Of Black or African American Beneficiaries |
64 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
13 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
305 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
7 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
43 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
3 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.9607 |