National Provider Identifier [NPI]: |
1194827105 |
Last Name Of The Provider |
KICKLAND |
First Name Of The Provider |
ERICH |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4005 ORCHARD DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
MIDLAND |
Zip Code Of The Provider |
486700001 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
32 |
Number Of Services |
1257 |
Number Of Medicare Beneficiaries |
771 |
Total Submitted Charge Amount |
309128 |
Total Medicare Allowed Amount |
134031.05 |
Total Medicare Payment Amount |
100336.92 |
Total Medicare Standardized Payment Amount |
101669.83 |
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 |
32 |
Number Of Medical Services |
1257 |
Number Of Medicare Beneficiaries With Medical Services |
771 |
Total Medical Submitted Charge Amount |
309128 |
Total Medical Medicare Allowed Amount |
134031.05 |
Total Medical Medicare Payment Amount |
100336.92 |
Total Medical Medicare Standardized Payment Amount |
101669.83 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
220 |
Number Of Beneficiaries Age 65 to 74 |
215 |
Number Of Beneficiaries Age 75 to 84 |
198 |
Number Of Beneficiaries Age Greater 84 |
138 |
Number Of Female Beneficiaries |
460 |
Number Of Male Beneficiaries |
311 |
Number Of Non Hispanic White Beneficiaries |
741 |
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 |
519 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
252 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
53 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.6721 |