National Provider Identifier [NPI]: |
1730164831 |
Last Name Of The Provider |
BUSHONG |
First Name Of The Provider |
TOBIN |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
PA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6560 FANNIN ST |
Street Address 2 Of The Provider |
SUITE 400 |
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770302761 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
39 |
Number Of Services |
1050 |
Number Of Medicare Beneficiaries |
163 |
Total Submitted Charge Amount |
334058 |
Total Medicare Allowed Amount |
57255.34 |
Total Medicare Payment Amount |
42740.3 |
Total Medicare Standardized Payment Amount |
46538.37 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
521 |
Number Of Medicare Beneficiaries With Drug Services |
90 |
Total Drug Submitted ChargeAmount |
64416 |
Total Drug Medicare AllowedAmount |
20793.38 |
Total Drug Medicare PaymentAmount |
16223.27 |
Total Drug Medicare Standardized Payment Amount |
16223.27 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
529 |
Number Of Medicare Beneficiaries With Medical Services |
163 |
Total Medical Submitted Charge Amount |
269642 |
Total Medical Medicare Allowed Amount |
36461.96 |
Total Medical Medicare Payment Amount |
26517.03 |
Total Medical Medicare Standardized Payment Amount |
30315.1 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
14 |
Number Of Beneficiaries Age 65 to 74 |
79 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
20 |
Number Of Female Beneficiaries |
105 |
Number Of Male Beneficiaries |
58 |
Number Of Non Hispanic White Beneficiaries |
123 |
Number Of Black or African American Beneficiaries |
26 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
7 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1164 |