National Provider Identifier [NPI]: |
1245266394 |
Last Name Of The Provider |
FAJOBI |
First Name Of The Provider |
OLUFUNKE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6835 BROADWAY AVE |
Street Address 2 Of The Provider |
METROHEALTH BROADWAY HEALTH CENTER |
City Of The Provider |
CLEVELAND |
Zip Code Of The Provider |
441051313 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
387 |
Number Of Medicare Beneficiaries |
186 |
Total Submitted Charge Amount |
58417 |
Total Medicare Allowed Amount |
23909.58 |
Total Medicare Payment Amount |
17232.18 |
Total Medicare Standardized Payment Amount |
17521.43 |
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 |
16 |
Number Of Medical Services |
387 |
Number Of Medicare Beneficiaries With Medical Services |
186 |
Total Medical Submitted Charge Amount |
58417 |
Total Medical Medicare Allowed Amount |
23909.58 |
Total Medical Medicare Payment Amount |
17232.18 |
Total Medical Medicare Standardized Payment Amount |
17521.43 |
Average Age Of Beneficiaries |
52 |
Number Of Beneficiaries Age Less65 |
155 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
114 |
Number Of Male Beneficiaries |
72 |
Number Of Non Hispanic White Beneficiaries |
124 |
Number Of Black or African American Beneficiaries |
41 |
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 |
53 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
133 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
69 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
42 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.381 |