National Provider Identifier [NPI]: |
1336330224 |
Last Name Of The Provider |
NGO |
First Name Of The Provider |
KHA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
26850 PROVIDENCE PKWY |
Street Address 2 Of The Provider |
SUITE 350 |
City Of The Provider |
NOVI |
Zip Code Of The Provider |
483741213 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
41 |
Number Of Services |
996 |
Number Of Medicare Beneficiaries |
420 |
Total Submitted Charge Amount |
206969 |
Total Medicare Allowed Amount |
117436.28 |
Total Medicare Payment Amount |
91541.09 |
Total Medicare Standardized Payment Amount |
88544.44 |
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 |
41 |
Number Of Medical Services |
996 |
Number Of Medicare Beneficiaries With Medical Services |
420 |
Total Medical Submitted Charge Amount |
206969 |
Total Medical Medicare Allowed Amount |
117436.28 |
Total Medical Medicare Payment Amount |
91541.09 |
Total Medical Medicare Standardized Payment Amount |
88544.44 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
86 |
Number Of Beneficiaries Age 65 to 74 |
125 |
Number Of Beneficiaries Age 75 to 84 |
120 |
Number Of Beneficiaries Age Greater 84 |
89 |
Number Of Female Beneficiaries |
247 |
Number Of Male Beneficiaries |
173 |
Number Of Non Hispanic White Beneficiaries |
244 |
Number Of Black or African American Beneficiaries |
161 |
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 |
328 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
92 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
26 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
48 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
53 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
61 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
56 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
2.3818 |