National Provider Identifier [NPI]: |
1417929779 |
Last Name Of The Provider |
EDMISTER |
First Name Of The Provider |
WHITNEY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D., PH.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2020 PALOMINO LN |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
LAS VEGAS |
Zip Code Of The Provider |
891064894 |
State Code Of The Provider |
NV |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
211 |
Number Of Services |
17620 |
Number Of Medicare Beneficiaries |
2589 |
Total Submitted Charge Amount |
1580640.06 |
Total Medicare Allowed Amount |
363264.99 |
Total Medicare Payment Amount |
276385.81 |
Total Medicare Standardized Payment Amount |
273303.76 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
14103 |
Number Of Medicare Beneficiaries With Drug Services |
159 |
Total Drug Submitted ChargeAmount |
42136.48 |
Total Drug Medicare AllowedAmount |
2962.74 |
Total Drug Medicare PaymentAmount |
2311.54 |
Total Drug Medicare Standardized Payment Amount |
2311.54 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
204 |
Number Of Medical Services |
3517 |
Number Of Medicare Beneficiaries With Medical Services |
2589 |
Total Medical Submitted Charge Amount |
1538503.58 |
Total Medical Medicare Allowed Amount |
360302.25 |
Total Medical Medicare Payment Amount |
274074.27 |
Total Medical Medicare Standardized Payment Amount |
270992.22 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
481 |
Number Of Beneficiaries Age 65 to 74 |
1134 |
Number Of Beneficiaries Age 75 to 84 |
706 |
Number Of Beneficiaries Age Greater 84 |
268 |
Number Of Female Beneficiaries |
1541 |
Number Of Male Beneficiaries |
1048 |
Number Of Non Hispanic White Beneficiaries |
1914 |
Number Of Black or African American Beneficiaries |
283 |
Number Of AsianPacific Islander Beneficiaries |
120 |
Number Of Hispanic Beneficiaries |
221 |
Number Of American Indian Alaska Native Beneficiaries |
11 |
Number Of Beneficiaries With Race Not Else where Classified |
40 |
Number Of Beneficiaries With Medicare Only Entitlement |
1953 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
636 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
16 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
1.7844 |