National Provider Identifier [NPI]: |
1720196785 |
Last Name Of The Provider |
VEIGEL |
First Name Of The Provider |
JAKE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2000 S 900 E |
Street Address 2 Of The Provider |
|
City Of The Provider |
SALT LAKE CITY |
Zip Code Of The Provider |
841053208 |
State Code Of The Provider |
UT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
46 |
Number Of Services |
487 |
Number Of Medicare Beneficiaries |
119 |
Total Submitted Charge Amount |
51245 |
Total Medicare Allowed Amount |
31585.08 |
Total Medicare Payment Amount |
23420.95 |
Total Medicare Standardized Payment Amount |
24385.71 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
151 |
Number Of Medicare Beneficiaries With Drug Services |
36 |
Total Drug Submitted ChargeAmount |
2022 |
Total Drug Medicare AllowedAmount |
744.08 |
Total Drug Medicare PaymentAmount |
583.49 |
Total Drug Medicare Standardized Payment Amount |
583.49 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
44 |
Number Of Medical Services |
336 |
Number Of Medicare Beneficiaries With Medical Services |
119 |
Total Medical Submitted Charge Amount |
49223 |
Total Medical Medicare Allowed Amount |
30841 |
Total Medical Medicare Payment Amount |
22837.46 |
Total Medical Medicare Standardized Payment Amount |
23802.22 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
48 |
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
13 |
Number Of Female Beneficiaries |
70 |
Number Of Male Beneficiaries |
49 |
Number Of Non Hispanic White Beneficiaries |
102 |
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 |
95 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
24 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
55 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0595 |