National Provider Identifier [NPI]: |
1437135373 |
Last Name Of The Provider |
BOLAND |
First Name Of The Provider |
ANTHONY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2500 N STATE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
JACKSON |
Zip Code Of The Provider |
392164500 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Vascular Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
84 |
Number Of Services |
865 |
Number Of Medicare Beneficiaries |
463 |
Total Submitted Charge Amount |
380722 |
Total Medicare Allowed Amount |
82900.85 |
Total Medicare Payment Amount |
64263.77 |
Total Medicare Standardized Payment Amount |
70357.2 |
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 |
84 |
Number Of Medical Services |
865 |
Number Of Medicare Beneficiaries With Medical Services |
463 |
Total Medical Submitted Charge Amount |
380722 |
Total Medical Medicare Allowed Amount |
82900.85 |
Total Medical Medicare Payment Amount |
64263.77 |
Total Medical Medicare Standardized Payment Amount |
70357.2 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
175 |
Number Of Beneficiaries Age 65 to 74 |
163 |
Number Of Beneficiaries Age 75 to 84 |
91 |
Number Of Beneficiaries Age Greater 84 |
34 |
Number Of Female Beneficiaries |
237 |
Number Of Male Beneficiaries |
226 |
Number Of Non Hispanic White Beneficiaries |
204 |
Number Of Black or African American Beneficiaries |
244 |
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 |
239 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
224 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
40 |
Percent Of With Chronic Kidney Disease |
53 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
30 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
23 |
Average HCC Risk Score Of Beneficiaries |
2.5005 |