National Provider Identifier [NPI]: |
1770740037 |
Last Name Of The Provider |
ASSEFA |
First Name Of The Provider |
DANIEL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
116 S STEWART ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
WINCHESTER |
Zip Code Of The Provider |
226014146 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
2035 |
Number Of Medicare Beneficiaries |
855 |
Total Submitted Charge Amount |
459190 |
Total Medicare Allowed Amount |
229823.48 |
Total Medicare Payment Amount |
177480.9 |
Total Medicare Standardized Payment Amount |
176549.12 |
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 |
19 |
Number Of Medical Services |
2035 |
Number Of Medicare Beneficiaries With Medical Services |
855 |
Total Medical Submitted Charge Amount |
459190 |
Total Medical Medicare Allowed Amount |
229823.48 |
Total Medical Medicare Payment Amount |
177480.9 |
Total Medical Medicare Standardized Payment Amount |
176549.12 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
110 |
Number Of Beneficiaries Age 65 to 74 |
283 |
Number Of Beneficiaries Age 75 to 84 |
279 |
Number Of Beneficiaries Age Greater 84 |
183 |
Number Of Female Beneficiaries |
507 |
Number Of Male Beneficiaries |
348 |
Number Of Non Hispanic White Beneficiaries |
780 |
Number Of Black or African American Beneficiaries |
55 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
644 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
211 |
Percent Of With Atrial Fibrillation |
26 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
48 |
Percent Of With Chronic Kidney Disease |
57 |
Percent Of With Chronic Obstructive Pulmonary Disease |
45 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
46 |
Percent Of With Hyperlipidemia |
72 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
57 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.06 |