National Provider Identifier [NPI]: |
1710922406 |
Last Name Of The Provider |
SEO |
First Name Of The Provider |
IN |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
121 DEKALB AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
BROOKLYN |
Zip Code Of The Provider |
112015425 |
State Code Of The Provider |
NY |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
531 |
Number Of Medicare Beneficiaries |
379 |
Total Submitted Charge Amount |
44255 |
Total Medicare Allowed Amount |
21217.01 |
Total Medicare Payment Amount |
16504.24 |
Total Medicare Standardized Payment Amount |
14889.95 |
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 |
23 |
Number Of Medical Services |
531 |
Number Of Medicare Beneficiaries With Medical Services |
379 |
Total Medical Submitted Charge Amount |
44255 |
Total Medical Medicare Allowed Amount |
21217.01 |
Total Medical Medicare Payment Amount |
16504.24 |
Total Medical Medicare Standardized Payment Amount |
14889.95 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
128 |
Number Of Beneficiaries Age 75 to 84 |
108 |
Number Of Beneficiaries Age Greater 84 |
70 |
Number Of Female Beneficiaries |
245 |
Number Of Male Beneficiaries |
134 |
Number Of Non Hispanic White Beneficiaries |
47 |
Number Of Black or African American Beneficiaries |
234 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
78 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
100 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
279 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
32 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
23 |
Percent Of With Heart Failure |
47 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
65 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
64 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.7969 |