National Provider Identifier [NPI]: |
1417108291 |
Last Name Of The Provider |
MOSBURG |
First Name Of The Provider |
JERAMY |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1951 N WILMOT RD |
Street Address 2 Of The Provider |
BLDG 4 |
City Of The Provider |
TUCSON |
Zip Code Of The Provider |
857128000 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pulmonary Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
47 |
Number Of Services |
2490 |
Number Of Medicare Beneficiaries |
657 |
Total Submitted Charge Amount |
276131.5 |
Total Medicare Allowed Amount |
231858.26 |
Total Medicare Payment Amount |
176699.75 |
Total Medicare Standardized Payment Amount |
181250.53 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
173 |
Number Of Medicare Beneficiaries With Drug Services |
65 |
Total Drug Submitted ChargeAmount |
735.5 |
Total Drug Medicare AllowedAmount |
709.12 |
Total Drug Medicare PaymentAmount |
653.92 |
Total Drug Medicare Standardized Payment Amount |
653.92 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
2317 |
Number Of Medicare Beneficiaries With Medical Services |
657 |
Total Medical Submitted Charge Amount |
275396 |
Total Medical Medicare Allowed Amount |
231149.14 |
Total Medical Medicare Payment Amount |
176045.83 |
Total Medical Medicare Standardized Payment Amount |
180596.61 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
69 |
Number Of Beneficiaries Age 65 to 74 |
252 |
Number Of Beneficiaries Age 75 to 84 |
244 |
Number Of Beneficiaries Age Greater 84 |
92 |
Number Of Female Beneficiaries |
326 |
Number Of Male Beneficiaries |
331 |
Number Of Non Hispanic White Beneficiaries |
558 |
Number Of Black or African American Beneficiaries |
18 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
63 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
543 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
114 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
27 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
47 |
Percent Of With Chronic Kidney Disease |
49 |
Percent Of With Chronic Obstructive Pulmonary Disease |
53 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
55 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.9204 |