National Provider Identifier [NPI]: |
1578559225 |
Last Name Of The Provider |
KOHANSKI |
First Name Of The Provider |
PHILLIP |
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 |
326 WASHINGTON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
NORWICH |
Zip Code Of The Provider |
063602740 |
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 |
222 |
Number Of Services |
8676 |
Number Of Medicare Beneficiaries |
4517 |
Total Submitted Charge Amount |
1248149 |
Total Medicare Allowed Amount |
263042.95 |
Total Medicare Payment Amount |
198901.43 |
Total Medicare Standardized Payment Amount |
190891.49 |
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 |
222 |
Number Of Medical Services |
8676 |
Number Of Medicare Beneficiaries With Medical Services |
4517 |
Total Medical Submitted Charge Amount |
1248149 |
Total Medical Medicare Allowed Amount |
263042.95 |
Total Medical Medicare Payment Amount |
198901.43 |
Total Medical Medicare Standardized Payment Amount |
190891.49 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
964 |
Number Of Beneficiaries Age 65 to 74 |
1574 |
Number Of Beneficiaries Age 75 to 84 |
1275 |
Number Of Beneficiaries Age Greater 84 |
704 |
Number Of Female Beneficiaries |
2772 |
Number Of Male Beneficiaries |
1745 |
Number Of Non Hispanic White Beneficiaries |
4064 |
Number Of Black or African American Beneficiaries |
161 |
Number Of AsianPacific Islander Beneficiaries |
49 |
Number Of Hispanic Beneficiaries |
135 |
Number Of American Indian Alaska Native Beneficiaries |
36 |
Number Of Beneficiaries With Race Not Else where Classified |
72 |
Number Of Beneficiaries With Medicare Only Entitlement |
2744 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
1773 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
35 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.6429 |