National Provider Identifier [NPI]: |
1982614665 |
Last Name Of The Provider |
QIDWAI |
First Name Of The Provider |
ANILA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1570 OLD ALABAMA RD |
Street Address 2 Of The Provider |
SUITE#105 |
City Of The Provider |
ROSWELL |
Zip Code Of The Provider |
300762108 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
42 |
Number Of Services |
852 |
Number Of Medicare Beneficiaries |
95 |
Total Submitted Charge Amount |
120675 |
Total Medicare Allowed Amount |
79975.9 |
Total Medicare Payment Amount |
59821.61 |
Total Medicare Standardized Payment Amount |
60993.23 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
25 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
1315 |
Total Drug Medicare AllowedAmount |
777.25 |
Total Drug Medicare PaymentAmount |
758.13 |
Total Drug Medicare Standardized Payment Amount |
758.13 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
36 |
Number Of Medical Services |
827 |
Number Of Medicare Beneficiaries With Medical Services |
95 |
Total Medical Submitted Charge Amount |
119360 |
Total Medical Medicare Allowed Amount |
79198.65 |
Total Medical Medicare Payment Amount |
59063.48 |
Total Medical Medicare Standardized Payment Amount |
60235.1 |
Average Age Of Beneficiaries |
82 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
26 |
Number Of Beneficiaries Age Greater 84 |
52 |
Number Of Female Beneficiaries |
67 |
Number Of Male Beneficiaries |
28 |
Number Of Non Hispanic White Beneficiaries |
83 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
84 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
75 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
46 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
59 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
48 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
26 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
48 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.924 |