National Provider Identifier [NPI]: |
1003918673 |
Last Name Of The Provider |
CARROLL |
First Name Of The Provider |
CHRISTOPHER |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
820 PRUDENTIAL DR |
Street Address 2 Of The Provider |
SUITE 304 |
City Of The Provider |
JACKSONVILLE |
Zip Code Of The Provider |
322078210 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
1464 |
Number Of Medicare Beneficiaries |
569 |
Total Submitted Charge Amount |
278460 |
Total Medicare Allowed Amount |
161175.88 |
Total Medicare Payment Amount |
125644.36 |
Total Medicare Standardized Payment Amount |
125506.34 |
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 |
20 |
Number Of Medical Services |
1464 |
Number Of Medicare Beneficiaries With Medical Services |
569 |
Total Medical Submitted Charge Amount |
278460 |
Total Medical Medicare Allowed Amount |
161175.88 |
Total Medical Medicare Payment Amount |
125644.36 |
Total Medical Medicare Standardized Payment Amount |
125506.34 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
109 |
Number Of Beneficiaries Age 65 to 74 |
181 |
Number Of Beneficiaries Age 75 to 84 |
174 |
Number Of Beneficiaries Age Greater 84 |
105 |
Number Of Female Beneficiaries |
321 |
Number Of Male Beneficiaries |
248 |
Number Of Non Hispanic White Beneficiaries |
428 |
Number Of Black or African American Beneficiaries |
119 |
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 |
426 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
143 |
Percent Of With Atrial Fibrillation |
30 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
46 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
66 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
19 |
Average HCC Risk Score Of Beneficiaries |
2.3694 |