National Provider Identifier [NPI]: |
1649299538 |
Last Name Of The Provider |
GONENNE |
First Name Of The Provider |
JONATHAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3355 RIVERBEND DR |
Street Address 2 Of The Provider |
SUITE 500 |
City Of The Provider |
SPRINGFIELD |
Zip Code Of The Provider |
974778800 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
75 |
Number Of Services |
1370 |
Number Of Medicare Beneficiaries |
477 |
Total Submitted Charge Amount |
793712 |
Total Medicare Allowed Amount |
168532.93 |
Total Medicare Payment Amount |
127070.78 |
Total Medicare Standardized Payment Amount |
131339.32 |
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 |
75 |
Number Of Medical Services |
1370 |
Number Of Medicare Beneficiaries With Medical Services |
477 |
Total Medical Submitted Charge Amount |
793712 |
Total Medical Medicare Allowed Amount |
168532.93 |
Total Medical Medicare Payment Amount |
127070.78 |
Total Medical Medicare Standardized Payment Amount |
131339.32 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
80 |
Number Of Beneficiaries Age 65 to 74 |
228 |
Number Of Beneficiaries Age 75 to 84 |
124 |
Number Of Beneficiaries Age Greater 84 |
45 |
Number Of Female Beneficiaries |
268 |
Number Of Male Beneficiaries |
209 |
Number Of Non Hispanic White Beneficiaries |
451 |
Number Of Black or African American Beneficiaries |
|
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 |
377 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
100 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.4614 |