National Provider Identifier [NPI]: |
1104839760 |
Last Name Of The Provider |
SIZEMORE |
First Name Of The Provider |
KENTON |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
945 GOETHALS DRIVE |
Street Address 2 Of The Provider |
SUITE 200 |
City Of The Provider |
RICHLAND |
Zip Code Of The Provider |
99352 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Obstetrics/Gynecology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
83 |
Number Of Medicare Beneficiaries |
42 |
Total Submitted Charge Amount |
36016.5 |
Total Medicare Allowed Amount |
18860.86 |
Total Medicare Payment Amount |
14135.71 |
Total Medicare Standardized Payment Amount |
14961.11 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
83 |
Number Of Medicare Beneficiaries With Medical Services |
42 |
Total Medical Submitted Charge Amount |
36016.5 |
Total Medical Medicare Allowed Amount |
18860.86 |
Total Medical Medicare Payment Amount |
14135.71 |
Total Medical Medicare Standardized Payment Amount |
14961.11 |
Average Age Of Beneficiaries |
59 |
Number Of Beneficiaries Age Less65 |
18 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
42 |
Number Of Male Beneficiaries |
0 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
25 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
17 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
31 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
26 |
Percent Of With Hypertension |
38 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8612 |