National Provider Identifier [NPI]: |
1184851792 |
Last Name Of The Provider |
CHOWDHURY |
First Name Of The Provider |
NAGIB |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2101 ELM ST N |
Street Address 2 Of The Provider |
|
City Of The Provider |
FARGO |
Zip Code Of The Provider |
581022417 |
State Code Of The Provider |
ND |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
866 |
Number Of Medicare Beneficiaries |
354 |
Total Submitted Charge Amount |
96469 |
Total Medicare Allowed Amount |
53707.41 |
Total Medicare Payment Amount |
36070.47 |
Total Medicare Standardized Payment Amount |
38874.34 |
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 |
11 |
Number Of Medical Services |
866 |
Number Of Medicare Beneficiaries With Medical Services |
354 |
Total Medical Submitted Charge Amount |
96469 |
Total Medical Medicare Allowed Amount |
53707.41 |
Total Medical Medicare Payment Amount |
36070.47 |
Total Medical Medicare Standardized Payment Amount |
38874.34 |
Average Age Of Beneficiaries |
53 |
Number Of Beneficiaries Age Less65 |
269 |
Number Of Beneficiaries Age 65 to 74 |
60 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
228 |
Number Of Male Beneficiaries |
126 |
Number Of Non Hispanic White Beneficiaries |
320 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
12 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
134 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
220 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
42 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3911 |