National Provider Identifier [NPI]: |
1134339203 |
Last Name Of The Provider |
ALLA |
First Name Of The Provider |
SURESH |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
400 JOHN DEERE RD BLDG 1 |
Street Address 2 Of The Provider |
|
City Of The Provider |
MOLINE |
Zip Code Of The Provider |
612656898 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nephrology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
13037 |
Number Of Medicare Beneficiaries |
901 |
Total Submitted Charge Amount |
828650 |
Total Medicare Allowed Amount |
447442.82 |
Total Medicare Payment Amount |
334866.69 |
Total Medicare Standardized Payment Amount |
349734.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
9674 |
Number Of Medicare Beneficiaries With Drug Services |
43 |
Total Drug Submitted ChargeAmount |
116080 |
Total Drug Medicare AllowedAmount |
35915.67 |
Total Drug Medicare PaymentAmount |
27512.09 |
Total Drug Medicare Standardized Payment Amount |
27512.09 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
3363 |
Number Of Medicare Beneficiaries With Medical Services |
901 |
Total Medical Submitted Charge Amount |
712570 |
Total Medical Medicare Allowed Amount |
411527.15 |
Total Medical Medicare Payment Amount |
307354.6 |
Total Medical Medicare Standardized Payment Amount |
322222.06 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
221 |
Number Of Beneficiaries Age 65 to 74 |
260 |
Number Of Beneficiaries Age 75 to 84 |
280 |
Number Of Beneficiaries Age Greater 84 |
140 |
Number Of Female Beneficiaries |
465 |
Number Of Male Beneficiaries |
436 |
Number Of Non Hispanic White Beneficiaries |
739 |
Number Of Black or African American Beneficiaries |
110 |
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 |
628 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
273 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
62 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
55 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
64 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
4.1901 |