National Provider Identifier [NPI]: |
1649271875 |
Last Name Of The Provider |
HERREN |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4901 GRANDE DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
PENSACOLA |
Zip Code Of The Provider |
325045935 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
297 |
Number Of Medicare Beneficiaries |
199 |
Total Submitted Charge Amount |
85654.61 |
Total Medicare Allowed Amount |
25008.49 |
Total Medicare Payment Amount |
19433.83 |
Total Medicare Standardized Payment Amount |
19153.64 |
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 |
35 |
Number Of Medical Services |
297 |
Number Of Medicare Beneficiaries With Medical Services |
199 |
Total Medical Submitted Charge Amount |
85654.61 |
Total Medical Medicare Allowed Amount |
25008.49 |
Total Medical Medicare Payment Amount |
19433.83 |
Total Medical Medicare Standardized Payment Amount |
19153.64 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
45 |
Number Of Beneficiaries Age 65 to 74 |
93 |
Number Of Beneficiaries Age 75 to 84 |
46 |
Number Of Beneficiaries Age Greater 84 |
15 |
Number Of Female Beneficiaries |
116 |
Number Of Male Beneficiaries |
83 |
Number Of Non Hispanic White Beneficiaries |
159 |
Number Of Black or African American Beneficiaries |
28 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
150 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
49 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
21 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
41 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
63 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.5703 |