National Provider Identifier [NPI]: |
1366737074 |
Last Name Of The Provider |
ALASADI |
First Name Of The Provider |
RUSUL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1901 W HARRISON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606123714 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
98 |
Number Of Medicare Beneficiaries |
52 |
Total Submitted Charge Amount |
9594 |
Total Medicare Allowed Amount |
5955.49 |
Total Medicare Payment Amount |
4675.09 |
Total Medicare Standardized Payment Amount |
4409.57 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
12 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
550 |
Total Drug Medicare AllowedAmount |
346.33 |
Total Drug Medicare PaymentAmount |
339.38 |
Total Drug Medicare Standardized Payment Amount |
339.38 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
86 |
Number Of Medicare Beneficiaries With Medical Services |
52 |
Total Medical Submitted Charge Amount |
9044 |
Total Medical Medicare Allowed Amount |
5609.16 |
Total Medical Medicare Payment Amount |
4335.71 |
Total Medical Medicare Standardized Payment Amount |
4070.19 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
16 |
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
37 |
Number Of Male Beneficiaries |
15 |
Number Of Non Hispanic White Beneficiaries |
15 |
Number Of Black or African American Beneficiaries |
13 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
24 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
17 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
35 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
27 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3907 |