National Provider Identifier [NPI]: |
1184670382 |
Last Name Of The Provider |
CORY |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
121 S SAINT LOUIS BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
SOUTH BEND |
Zip Code Of The Provider |
466172924 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
153 |
Number Of Services |
4841 |
Number Of Medicare Beneficiaries |
2534 |
Total Submitted Charge Amount |
527191.22 |
Total Medicare Allowed Amount |
168171.81 |
Total Medicare Payment Amount |
127758.43 |
Total Medicare Standardized Payment Amount |
135598 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
938 |
Number Of Medicare Beneficiaries With Drug Services |
71 |
Total Drug Submitted ChargeAmount |
2060.91 |
Total Drug Medicare AllowedAmount |
2012.47 |
Total Drug Medicare PaymentAmount |
1570.43 |
Total Drug Medicare Standardized Payment Amount |
1570.43 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
149 |
Number Of Medical Services |
3903 |
Number Of Medicare Beneficiaries With Medical Services |
2534 |
Total Medical Submitted Charge Amount |
525130.31 |
Total Medical Medicare Allowed Amount |
166159.34 |
Total Medical Medicare Payment Amount |
126188 |
Total Medical Medicare Standardized Payment Amount |
134027.57 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
414 |
Number Of Beneficiaries Age 65 to 74 |
920 |
Number Of Beneficiaries Age 75 to 84 |
726 |
Number Of Beneficiaries Age Greater 84 |
474 |
Number Of Female Beneficiaries |
1539 |
Number Of Male Beneficiaries |
995 |
Number Of Non Hispanic White Beneficiaries |
2304 |
Number Of Black or African American Beneficiaries |
156 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
40 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
19 |
Number Of Beneficiaries With Medicare Only Entitlement |
1962 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
572 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
16 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
36 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.7156 |