National Provider Identifier [NPI]: |
1245544998 |
Last Name Of The Provider |
SOBOH |
First Name Of The Provider |
KHALIL |
Middle Initial Of The Provider |
I |
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2100 DORCHESTER AVE |
Street Address 2 Of The Provider |
CARNEY HOSPITAL |
City Of The Provider |
DORCHESTER CENTER |
Zip Code Of The Provider |
021245615 |
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 |
21 |
Number Of Services |
2058 |
Number Of Medicare Beneficiaries |
578 |
Total Submitted Charge Amount |
322707 |
Total Medicare Allowed Amount |
177544.52 |
Total Medicare Payment Amount |
136923.86 |
Total Medicare Standardized Payment Amount |
144078.25 |
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 |
21 |
Number Of Medical Services |
2058 |
Number Of Medicare Beneficiaries With Medical Services |
578 |
Total Medical Submitted Charge Amount |
322707 |
Total Medical Medicare Allowed Amount |
177544.52 |
Total Medical Medicare Payment Amount |
136923.86 |
Total Medical Medicare Standardized Payment Amount |
144078.25 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
146 |
Number Of Beneficiaries Age 65 to 74 |
174 |
Number Of Beneficiaries Age 75 to 84 |
157 |
Number Of Beneficiaries Age Greater 84 |
101 |
Number Of Female Beneficiaries |
310 |
Number Of Male Beneficiaries |
268 |
Number Of Non Hispanic White Beneficiaries |
550 |
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 |
325 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
253 |
Percent Of With Atrial Fibrillation |
27 |
Percent Of With Alzheimers Disease or Dementia |
28 |
Percent Of With Asthma |
20 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
56 |
Percent Of With Chronic Kidney Disease |
65 |
Percent Of With Chronic Obstructive Pulmonary Disease |
45 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
74 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
2.446 |