National Provider Identifier [NPI]: |
1720003569 |
Last Name Of The Provider |
GRAHAM |
First Name Of The Provider |
CAMILLE |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4000 MEDICAL PKWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
GREENVILLE |
Zip Code Of The Provider |
754017854 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Otolaryngology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
62 |
Number Of Services |
14506 |
Number Of Medicare Beneficiaries |
510 |
Total Submitted Charge Amount |
773975 |
Total Medicare Allowed Amount |
304968.83 |
Total Medicare Payment Amount |
225838.19 |
Total Medicare Standardized Payment Amount |
228406.64 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
152 |
Number Of Medicare Beneficiaries With Drug Services |
31 |
Total Drug Submitted ChargeAmount |
1064 |
Total Drug Medicare AllowedAmount |
270.64 |
Total Drug Medicare PaymentAmount |
200.85 |
Total Drug Medicare Standardized Payment Amount |
200.85 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
61 |
Number Of Medical Services |
14354 |
Number Of Medicare Beneficiaries With Medical Services |
510 |
Total Medical Submitted Charge Amount |
772911 |
Total Medical Medicare Allowed Amount |
304698.19 |
Total Medical Medicare Payment Amount |
225637.34 |
Total Medical Medicare Standardized Payment Amount |
228205.79 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
90 |
Number Of Beneficiaries Age 65 to 74 |
236 |
Number Of Beneficiaries Age 75 to 84 |
139 |
Number Of Beneficiaries Age Greater 84 |
45 |
Number Of Female Beneficiaries |
338 |
Number Of Male Beneficiaries |
172 |
Number Of Non Hispanic White Beneficiaries |
419 |
Number Of Black or African American Beneficiaries |
65 |
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 |
407 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
103 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.0255 |