National Provider Identifier [NPI]: |
1164470563 |
Last Name Of The Provider |
DOLE |
First Name Of The Provider |
POLLY |
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 |
3300 GALLOWS RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
FALLS CHURCH |
Zip Code Of The Provider |
220423307 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
431 |
Number Of Medicare Beneficiaries |
407 |
Total Submitted Charge Amount |
123494.96 |
Total Medicare Allowed Amount |
69585.1 |
Total Medicare Payment Amount |
52404.76 |
Total Medicare Standardized Payment Amount |
51790.11 |
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 |
15 |
Number Of Medical Services |
431 |
Number Of Medicare Beneficiaries With Medical Services |
407 |
Total Medical Submitted Charge Amount |
123494.96 |
Total Medical Medicare Allowed Amount |
69585.1 |
Total Medical Medicare Payment Amount |
52404.76 |
Total Medical Medicare Standardized Payment Amount |
51790.11 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
98 |
Number Of Beneficiaries Age 65 to 74 |
109 |
Number Of Beneficiaries Age 75 to 84 |
121 |
Number Of Beneficiaries Age Greater 84 |
79 |
Number Of Female Beneficiaries |
254 |
Number Of Male Beneficiaries |
153 |
Number Of Non Hispanic White Beneficiaries |
298 |
Number Of Black or African American Beneficiaries |
90 |
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 |
280 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
127 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
39 |
Percent Of With Chronic Kidney Disease |
45 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
56 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.0499 |