National Provider Identifier [NPI]: |
1013143023 |
Last Name Of The Provider |
EVEN |
First Name Of The Provider |
MICHELE |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
57 PINE RIDGE RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
FAIRFIELD |
Zip Code Of The Provider |
068251238 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
125 |
Number Of Services |
7400 |
Number Of Medicare Beneficiaries |
2231 |
Total Submitted Charge Amount |
697166 |
Total Medicare Allowed Amount |
222381.61 |
Total Medicare Payment Amount |
184941.61 |
Total Medicare Standardized Payment Amount |
170822.02 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
3611 |
Number Of Medicare Beneficiaries With Drug Services |
36 |
Total Drug Submitted ChargeAmount |
3104 |
Total Drug Medicare AllowedAmount |
969.02 |
Total Drug Medicare PaymentAmount |
759.67 |
Total Drug Medicare Standardized Payment Amount |
759.67 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
123 |
Number Of Medical Services |
3789 |
Number Of Medicare Beneficiaries With Medical Services |
2231 |
Total Medical Submitted Charge Amount |
694062 |
Total Medical Medicare Allowed Amount |
221412.59 |
Total Medical Medicare Payment Amount |
184181.94 |
Total Medical Medicare Standardized Payment Amount |
170062.35 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
300 |
Number Of Beneficiaries Age 65 to 74 |
870 |
Number Of Beneficiaries Age 75 to 84 |
686 |
Number Of Beneficiaries Age Greater 84 |
375 |
Number Of Female Beneficiaries |
1639 |
Number Of Male Beneficiaries |
592 |
Number Of Non Hispanic White Beneficiaries |
1688 |
Number Of Black or African American Beneficiaries |
269 |
Number Of AsianPacific Islander Beneficiaries |
36 |
Number Of Hispanic Beneficiaries |
206 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
32 |
Number Of Beneficiaries With Medicare Only Entitlement |
1541 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
690 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
16 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
31 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.6658 |