National Provider Identifier [NPI]: |
1639172570 |
Last Name Of The Provider |
HEAD |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1407 SPRING ST |
Street Address 2 Of The Provider |
STE 1 |
City Of The Provider |
JEFFERSONVILLE |
Zip Code Of The Provider |
471303748 |
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 |
47 |
Number Of Services |
2591 |
Number Of Medicare Beneficiaries |
452 |
Total Submitted Charge Amount |
200504 |
Total Medicare Allowed Amount |
169571.05 |
Total Medicare Payment Amount |
121757.35 |
Total Medicare Standardized Payment Amount |
129408.45 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
139 |
Number Of Medicare Beneficiaries With Drug Services |
102 |
Total Drug Submitted ChargeAmount |
3463 |
Total Drug Medicare AllowedAmount |
2934.47 |
Total Drug Medicare PaymentAmount |
2700.79 |
Total Drug Medicare Standardized Payment Amount |
2700.79 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
2452 |
Number Of Medicare Beneficiaries With Medical Services |
451 |
Total Medical Submitted Charge Amount |
197041 |
Total Medical Medicare Allowed Amount |
166636.58 |
Total Medical Medicare Payment Amount |
119056.56 |
Total Medical Medicare Standardized Payment Amount |
126707.66 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
64 |
Number Of Beneficiaries Age 65 to 74 |
144 |
Number Of Beneficiaries Age 75 to 84 |
147 |
Number Of Beneficiaries Age Greater 84 |
97 |
Number Of Female Beneficiaries |
264 |
Number Of Male Beneficiaries |
188 |
Number Of Non Hispanic White Beneficiaries |
423 |
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 |
306 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
146 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
33 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.7538 |