National Provider Identifier [NPI]: |
1063539252 |
Last Name Of The Provider |
GASKIN |
First Name Of The Provider |
FRED |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
309 GARRETT ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
FREDERICKTOWN |
Zip Code Of The Provider |
636451084 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
8 |
Number Of Services |
655 |
Number Of Medicare Beneficiaries |
217 |
Total Submitted Charge Amount |
53904.72 |
Total Medicare Allowed Amount |
48086.67 |
Total Medicare Payment Amount |
33833.46 |
Total Medicare Standardized Payment Amount |
37208.08 |
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 |
8 |
Number Of Medical Services |
655 |
Number Of Medicare Beneficiaries With Medical Services |
217 |
Total Medical Submitted Charge Amount |
53904.72 |
Total Medical Medicare Allowed Amount |
48086.67 |
Total Medical Medicare Payment Amount |
33833.46 |
Total Medical Medicare Standardized Payment Amount |
37208.08 |
Average Age Of Beneficiaries |
52 |
Number Of Beneficiaries Age Less65 |
180 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
128 |
Number Of Male Beneficiaries |
89 |
Number Of Non Hispanic White Beneficiaries |
205 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
52 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
165 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
29 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
50 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
28 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2048 |