National Provider Identifier [NPI]: |
1760491419 |
Last Name Of The Provider |
FONG |
First Name Of The Provider |
JIAN |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
619 19TH STREET SOUTH |
Street Address 2 Of The Provider |
|
City Of The Provider |
BIRMINGHAM |
Zip Code Of The Provider |
35233 |
State Code Of The Provider |
AL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
83 |
Number Of Services |
1365 |
Number Of Medicare Beneficiaries |
211 |
Total Submitted Charge Amount |
65271.65 |
Total Medicare Allowed Amount |
39384.62 |
Total Medicare Payment Amount |
27069.62 |
Total Medicare Standardized Payment Amount |
29809.68 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
17 |
Number Of Drug Services |
310 |
Number Of Medicare Beneficiaries With Drug Services |
88 |
Total Drug Submitted ChargeAmount |
3963.8 |
Total Drug Medicare AllowedAmount |
1648.84 |
Total Drug Medicare PaymentAmount |
1276.76 |
Total Drug Medicare Standardized Payment Amount |
1276.76 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
66 |
Number Of Medical Services |
1055 |
Number Of Medicare Beneficiaries With Medical Services |
211 |
Total Medical Submitted Charge Amount |
61307.85 |
Total Medical Medicare Allowed Amount |
37735.78 |
Total Medical Medicare Payment Amount |
25792.86 |
Total Medical Medicare Standardized Payment Amount |
28532.92 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
114 |
Number Of Beneficiaries Age 75 to 84 |
48 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
135 |
Number Of Male Beneficiaries |
76 |
Number Of Non Hispanic White Beneficiaries |
170 |
Number Of Black or African American Beneficiaries |
30 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
190 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
21 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7555 |