National Provider Identifier [NPI]: |
1376594457 |
Last Name Of The Provider |
WOLFE |
First Name Of The Provider |
CHARLES |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
915 E 1ST ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
DULUTH |
Zip Code Of The Provider |
558052107 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
213 |
Number Of Medicare Beneficiaries |
173 |
Total Submitted Charge Amount |
68854.3 |
Total Medicare Allowed Amount |
32535.85 |
Total Medicare Payment Amount |
24954.94 |
Total Medicare Standardized Payment Amount |
25721.96 |
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 |
15 |
Number Of Medical Services |
213 |
Number Of Medicare Beneficiaries With Medical Services |
173 |
Total Medical Submitted Charge Amount |
68854.3 |
Total Medical Medicare Allowed Amount |
32535.85 |
Total Medical Medicare Payment Amount |
24954.94 |
Total Medical Medicare Standardized Payment Amount |
25721.96 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
40 |
Number Of Beneficiaries Age 75 to 84 |
47 |
Number Of Beneficiaries Age Greater 84 |
45 |
Number Of Female Beneficiaries |
86 |
Number Of Male Beneficiaries |
87 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
113 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
60 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
42 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
16 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.7405 |