National Provider Identifier [NPI]: |
1396956165 |
Last Name Of The Provider |
PRUETT |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1908 ROYAL AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MONROE |
Zip Code Of The Provider |
712015724 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nephrology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
1754 |
Number Of Medicare Beneficiaries |
496 |
Total Submitted Charge Amount |
516408 |
Total Medicare Allowed Amount |
222814.39 |
Total Medicare Payment Amount |
170121.94 |
Total Medicare Standardized Payment Amount |
178116.22 |
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 |
1754 |
Number Of Medicare Beneficiaries With Medical Services |
496 |
Total Medical Submitted Charge Amount |
516408 |
Total Medical Medicare Allowed Amount |
222814.39 |
Total Medical Medicare Payment Amount |
170121.94 |
Total Medical Medicare Standardized Payment Amount |
178116.22 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
153 |
Number Of Beneficiaries Age 65 to 74 |
141 |
Number Of Beneficiaries Age 75 to 84 |
135 |
Number Of Beneficiaries Age Greater 84 |
67 |
Number Of Female Beneficiaries |
250 |
Number Of Male Beneficiaries |
246 |
Number Of Non Hispanic White Beneficiaries |
243 |
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 |
263 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
233 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
67 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
30 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
66 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
73 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
4.6379 |