National Provider Identifier [NPI]: |
1649257874 |
Last Name Of The Provider |
KONG |
First Name Of The Provider |
ROBERTO |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1 WYOMING ST |
Street Address 2 Of The Provider |
3 FL / ANESTHESIA DEPT |
City Of The Provider |
DAYTON |
Zip Code Of The Provider |
454092722 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
72 |
Number Of Services |
627 |
Number Of Medicare Beneficiaries |
519 |
Total Submitted Charge Amount |
660272.4 |
Total Medicare Allowed Amount |
66557.98 |
Total Medicare Payment Amount |
51847.15 |
Total Medicare Standardized Payment Amount |
52508.32 |
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 |
72 |
Number Of Medical Services |
627 |
Number Of Medicare Beneficiaries With Medical Services |
519 |
Total Medical Submitted Charge Amount |
660272.4 |
Total Medical Medicare Allowed Amount |
66557.98 |
Total Medical Medicare Payment Amount |
51847.15 |
Total Medical Medicare Standardized Payment Amount |
52508.32 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
105 |
Number Of Beneficiaries Age 65 to 74 |
193 |
Number Of Beneficiaries Age 75 to 84 |
157 |
Number Of Beneficiaries Age Greater 84 |
64 |
Number Of Female Beneficiaries |
292 |
Number Of Male Beneficiaries |
227 |
Number Of Non Hispanic White Beneficiaries |
482 |
Number Of Black or African American Beneficiaries |
20 |
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 |
395 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
124 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.3531 |