National Provider Identifier [NPI]: |
1790788545 |
Last Name Of The Provider |
BRAHAM |
First Name Of The Provider |
JEFFERY |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
800 GRAND CENTRAL MALL |
Street Address 2 Of The Provider |
SUITE 4 |
City Of The Provider |
VIENNA |
Zip Code Of The Provider |
261054131 |
State Code Of The Provider |
WV |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
109 |
Number Of Services |
6470 |
Number Of Medicare Beneficiaries |
731 |
Total Submitted Charge Amount |
791303.34 |
Total Medicare Allowed Amount |
274987.76 |
Total Medicare Payment Amount |
209001.32 |
Total Medicare Standardized Payment Amount |
222831 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
270 |
Number Of Medicare Beneficiaries With Drug Services |
166 |
Total Drug Submitted ChargeAmount |
11330 |
Total Drug Medicare AllowedAmount |
7859.28 |
Total Drug Medicare PaymentAmount |
7079.16 |
Total Drug Medicare Standardized Payment Amount |
7079.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
98 |
Number Of Medical Services |
6200 |
Number Of Medicare Beneficiaries With Medical Services |
731 |
Total Medical Submitted Charge Amount |
779973.34 |
Total Medical Medicare Allowed Amount |
267128.48 |
Total Medical Medicare Payment Amount |
201922.16 |
Total Medical Medicare Standardized Payment Amount |
215751.84 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
118 |
Number Of Beneficiaries Age 65 to 74 |
380 |
Number Of Beneficiaries Age 75 to 84 |
182 |
Number Of Beneficiaries Age Greater 84 |
51 |
Number Of Female Beneficiaries |
346 |
Number Of Male Beneficiaries |
385 |
Number Of Non Hispanic White Beneficiaries |
713 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
630 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
101 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
3 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8815 |