National Provider Identifier [NPI]: |
1083825202 |
Last Name Of The Provider |
DECESARE |
First Name Of The Provider |
LINDA |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1100 SOUTHFIELD DR |
Street Address 2 Of The Provider |
SUITE 1220 |
City Of The Provider |
PLAINFIELD |
Zip Code Of The Provider |
461684498 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
307 |
Number Of Medicare Beneficiaries |
131 |
Total Submitted Charge Amount |
29503 |
Total Medicare Allowed Amount |
21888.51 |
Total Medicare Payment Amount |
15049.84 |
Total Medicare Standardized Payment Amount |
16038.02 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
26 |
Number Of Medicare Beneficiaries With Drug Services |
26 |
Total Drug Submitted ChargeAmount |
1064 |
Total Drug Medicare AllowedAmount |
603.46 |
Total Drug Medicare PaymentAmount |
591.38 |
Total Drug Medicare Standardized Payment Amount |
591.38 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
17 |
Number Of Medical Services |
281 |
Number Of Medicare Beneficiaries With Medical Services |
131 |
Total Medical Submitted Charge Amount |
28439 |
Total Medical Medicare Allowed Amount |
21285.05 |
Total Medical Medicare Payment Amount |
14458.46 |
Total Medical Medicare Standardized Payment Amount |
15446.64 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
62 |
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
102 |
Number Of Male Beneficiaries |
29 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
116 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
15 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
48 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9442 |