National Provider Identifier [NPI]: |
1104813096 |
Last Name Of The Provider |
WATERS |
First Name Of The Provider |
MARK |
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 |
2600 OLD WASHINGTON RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
UPPER ST CLAIR |
Zip Code Of The Provider |
152412524 |
State Code Of The Provider |
PA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
243 |
Number Of Medicare Beneficiaries |
140 |
Total Submitted Charge Amount |
36200 |
Total Medicare Allowed Amount |
16712.82 |
Total Medicare Payment Amount |
11522.55 |
Total Medicare Standardized Payment Amount |
12058.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
21 |
Number Of Medicare Beneficiaries With Drug Services |
18 |
Total Drug Submitted ChargeAmount |
410 |
Total Drug Medicare AllowedAmount |
186.3 |
Total Drug Medicare PaymentAmount |
171.45 |
Total Drug Medicare Standardized Payment Amount |
171.45 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
222 |
Number Of Medicare Beneficiaries With Medical Services |
140 |
Total Medical Submitted Charge Amount |
35790 |
Total Medical Medicare Allowed Amount |
16526.52 |
Total Medical Medicare Payment Amount |
11351.1 |
Total Medical Medicare Standardized Payment Amount |
11887.25 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
13 |
Number Of Beneficiaries Age 65 to 74 |
52 |
Number Of Beneficiaries Age 75 to 84 |
45 |
Number Of Beneficiaries Age Greater 84 |
30 |
Number Of Female Beneficiaries |
95 |
Number Of Male Beneficiaries |
45 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
|
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
15 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
48 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8447 |