National Provider Identifier [NPI]: |
1356533178 |
Last Name Of The Provider |
WILGUS |
First Name Of The Provider |
MAY |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6620 MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770302348 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Critical Care (Intensivists) |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
1653 |
Number Of Medicare Beneficiaries |
440 |
Total Submitted Charge Amount |
473572.5 |
Total Medicare Allowed Amount |
200179.19 |
Total Medicare Payment Amount |
155203.91 |
Total Medicare Standardized Payment Amount |
145581.54 |
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 |
36 |
Number Of Medical Services |
1653 |
Number Of Medicare Beneficiaries With Medical Services |
440 |
Total Medical Submitted Charge Amount |
473572.5 |
Total Medical Medicare Allowed Amount |
200179.19 |
Total Medical Medicare Payment Amount |
155203.91 |
Total Medical Medicare Standardized Payment Amount |
145581.54 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
67 |
Number Of Beneficiaries Age 65 to 74 |
130 |
Number Of Beneficiaries Age 75 to 84 |
152 |
Number Of Beneficiaries Age Greater 84 |
91 |
Number Of Female Beneficiaries |
212 |
Number Of Male Beneficiaries |
228 |
Number Of Non Hispanic White Beneficiaries |
197 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
40 |
Number Of Hispanic Beneficiaries |
179 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
228 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
212 |
Percent Of With Atrial Fibrillation |
26 |
Percent Of With Alzheimers Disease or Dementia |
21 |
Percent Of With Asthma |
21 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
58 |
Percent Of With Chronic Kidney Disease |
53 |
Percent Of With Chronic Obstructive Pulmonary Disease |
53 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
58 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
68 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.691 |