National Provider Identifier [NPI]: |
1801871165 |
Last Name Of The Provider |
MIN |
First Name Of The Provider |
JAMES |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
15195 HEATHCOAT BLVD |
Street Address 2 Of The Provider |
SUITE 338 |
City Of The Provider |
HAYMARKET |
Zip Code Of The Provider |
201696244 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
1126 |
Number Of Medicare Beneficiaries |
268 |
Total Submitted Charge Amount |
166470 |
Total Medicare Allowed Amount |
84493.78 |
Total Medicare Payment Amount |
60559.94 |
Total Medicare Standardized Payment Amount |
62777.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
116 |
Number Of Medicare Beneficiaries With Drug Services |
89 |
Total Drug Submitted ChargeAmount |
7117 |
Total Drug Medicare AllowedAmount |
4297.67 |
Total Drug Medicare PaymentAmount |
4135.42 |
Total Drug Medicare Standardized Payment Amount |
4135.42 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
1010 |
Number Of Medicare Beneficiaries With Medical Services |
268 |
Total Medical Submitted Charge Amount |
159353 |
Total Medical Medicare Allowed Amount |
80196.11 |
Total Medical Medicare Payment Amount |
56424.52 |
Total Medical Medicare Standardized Payment Amount |
58641.73 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
14 |
Number Of Beneficiaries Age 65 to 74 |
156 |
Number Of Beneficiaries Age 75 to 84 |
74 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
136 |
Number Of Male Beneficiaries |
132 |
Number Of Non Hispanic White Beneficiaries |
201 |
Number Of Black or African American Beneficiaries |
14 |
Number Of AsianPacific Islander Beneficiaries |
30 |
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 |
257 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
0.9345 |