National Provider Identifier [NPI]: |
1891779922 |
Last Name Of The Provider |
CLASS |
First Name Of The Provider |
CHARLES |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6905 HOOVER RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462604124 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
2185 |
Number Of Medicare Beneficiaries |
475 |
Total Submitted Charge Amount |
294316 |
Total Medicare Allowed Amount |
170810.29 |
Total Medicare Payment Amount |
125362.75 |
Total Medicare Standardized Payment Amount |
132582.17 |
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 |
16 |
Number Of Medical Services |
2185 |
Number Of Medicare Beneficiaries With Medical Services |
475 |
Total Medical Submitted Charge Amount |
294316 |
Total Medical Medicare Allowed Amount |
170810.29 |
Total Medical Medicare Payment Amount |
125362.75 |
Total Medical Medicare Standardized Payment Amount |
132582.17 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
43 |
Number Of Beneficiaries Age 65 to 74 |
138 |
Number Of Beneficiaries Age 75 to 84 |
184 |
Number Of Beneficiaries Age Greater 84 |
110 |
Number Of Female Beneficiaries |
328 |
Number Of Male Beneficiaries |
147 |
Number Of Non Hispanic White Beneficiaries |
427 |
Number Of Black or African American Beneficiaries |
|
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 |
400 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
75 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
51 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
29 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.4662 |