National Provider Identifier [NPI]: |
1578550612 |
Last Name Of The Provider |
WAGNER |
First Name Of The Provider |
JOSEPH |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
85 SEYMOUR ST |
Street Address 2 Of The Provider |
STE 416 |
City Of The Provider |
HARTFORD |
Zip Code Of The Provider |
061065501 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
1263 |
Number Of Medicare Beneficiaries |
522 |
Total Submitted Charge Amount |
738358.5 |
Total Medicare Allowed Amount |
244002.26 |
Total Medicare Payment Amount |
185457.93 |
Total Medicare Standardized Payment Amount |
179549.12 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
234 |
Number Of Medicare Beneficiaries With Drug Services |
39 |
Total Drug Submitted ChargeAmount |
112272 |
Total Drug Medicare AllowedAmount |
42798.65 |
Total Drug Medicare PaymentAmount |
33504.95 |
Total Drug Medicare Standardized Payment Amount |
33504.95 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
54 |
Number Of Medical Services |
1029 |
Number Of Medicare Beneficiaries With Medical Services |
522 |
Total Medical Submitted Charge Amount |
626086.5 |
Total Medical Medicare Allowed Amount |
201203.61 |
Total Medical Medicare Payment Amount |
151952.98 |
Total Medical Medicare Standardized Payment Amount |
146044.17 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
332 |
Number Of Beneficiaries Age 75 to 84 |
126 |
Number Of Beneficiaries Age Greater 84 |
38 |
Number Of Female Beneficiaries |
38 |
Number Of Male Beneficiaries |
484 |
Number Of Non Hispanic White Beneficiaries |
455 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
21 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
23 |
Number Of Beneficiaries With Medicare Only Entitlement |
464 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
58 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
64 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
3 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
25 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.1033 |