National Provider Identifier [NPI]: |
1720003148 |
Last Name Of The Provider |
KENYON |
First Name Of The Provider |
PAUL |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5950 SARATOGA BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
CORPUS CHRISTI |
Zip Code Of The Provider |
784144100 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
857 |
Number Of Medicare Beneficiaries |
567 |
Total Submitted Charge Amount |
918471 |
Total Medicare Allowed Amount |
104171.85 |
Total Medicare Payment Amount |
79170.71 |
Total Medicare Standardized Payment Amount |
81654.32 |
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 |
22 |
Number Of Medical Services |
857 |
Number Of Medicare Beneficiaries With Medical Services |
567 |
Total Medical Submitted Charge Amount |
918471 |
Total Medical Medicare Allowed Amount |
104171.85 |
Total Medical Medicare Payment Amount |
79170.71 |
Total Medical Medicare Standardized Payment Amount |
81654.32 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
166 |
Number Of Beneficiaries Age 65 to 74 |
165 |
Number Of Beneficiaries Age 75 to 84 |
138 |
Number Of Beneficiaries Age Greater 84 |
98 |
Number Of Female Beneficiaries |
305 |
Number Of Male Beneficiaries |
262 |
Number Of Non Hispanic White Beneficiaries |
253 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
285 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
275 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
292 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
35 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
58 |
Percent Of With Chronic Kidney Disease |
57 |
Percent Of With Chronic Obstructive Pulmonary Disease |
41 |
Percent Of With Depression |
46 |
Percent Of With Diabetes |
64 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
70 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
22 |
Average HCC Risk Score Of Beneficiaries |
3.1884 |