National Provider Identifier [NPI]: |
1508919077 |
Last Name Of The Provider |
GEMMA |
First Name Of The Provider |
RONALD |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3750 GUION RD. |
Street Address 2 Of The Provider |
STE. 185 |
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
46222 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
2426 |
Number Of Medicare Beneficiaries |
221 |
Total Submitted Charge Amount |
176404 |
Total Medicare Allowed Amount |
100705.85 |
Total Medicare Payment Amount |
71276.12 |
Total Medicare Standardized Payment Amount |
76952.24 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
259 |
Number Of Medicare Beneficiaries With Drug Services |
130 |
Total Drug Submitted ChargeAmount |
9445 |
Total Drug Medicare AllowedAmount |
6272.82 |
Total Drug Medicare PaymentAmount |
5826.78 |
Total Drug Medicare Standardized Payment Amount |
5826.78 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
47 |
Number Of Medical Services |
2167 |
Number Of Medicare Beneficiaries With Medical Services |
220 |
Total Medical Submitted Charge Amount |
166959 |
Total Medical Medicare Allowed Amount |
94433.03 |
Total Medical Medicare Payment Amount |
65449.34 |
Total Medical Medicare Standardized Payment Amount |
71125.46 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
34 |
Number Of Beneficiaries Age 65 to 74 |
106 |
Number Of Beneficiaries Age 75 to 84 |
63 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
119 |
Number Of Male Beneficiaries |
102 |
Number Of Non Hispanic White Beneficiaries |
175 |
Number Of Black or African American Beneficiaries |
|
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 |
196 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
25 |
Percent Of With Atrial Fibrillation |
5 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
35 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9844 |