National Provider Identifier [NPI]: |
1548285703 |
Last Name Of The Provider |
OFORI |
First Name Of The Provider |
SAMUEL |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2501 N PATTERSON ST |
Street Address 2 Of The Provider |
SOUTH GEORGIA MEDICAL CENTER |
City Of The Provider |
VALDOSTA |
Zip Code Of The Provider |
316021735 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Hematology/Oncology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
13 |
Number Of Services |
1751 |
Number Of Medicare Beneficiaries |
536 |
Total Submitted Charge Amount |
250971.25 |
Total Medicare Allowed Amount |
139259.8 |
Total Medicare Payment Amount |
102821.81 |
Total Medicare Standardized Payment Amount |
109829.67 |
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 |
13 |
Number Of Medical Services |
1751 |
Number Of Medicare Beneficiaries With Medical Services |
536 |
Total Medical Submitted Charge Amount |
250971.25 |
Total Medical Medicare Allowed Amount |
139259.8 |
Total Medical Medicare Payment Amount |
102821.81 |
Total Medical Medicare Standardized Payment Amount |
109829.67 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
131 |
Number Of Beneficiaries Age 65 to 74 |
226 |
Number Of Beneficiaries Age 75 to 84 |
137 |
Number Of Beneficiaries Age Greater 84 |
42 |
Number Of Female Beneficiaries |
308 |
Number Of Male Beneficiaries |
228 |
Number Of Non Hispanic White Beneficiaries |
271 |
Number Of Black or African American Beneficiaries |
251 |
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 |
352 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
184 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
38 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
45 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
2.0187 |