National Provider Identifier [NPI]: |
1720044217 |
Last Name Of The Provider |
MATHEW |
First Name Of The Provider |
SAGI |
Middle Initial Of The Provider |
V |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
10122 E 10TH STREET |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462292697 |
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 |
29 |
Number Of Services |
290 |
Number Of Medicare Beneficiaries |
149 |
Total Submitted Charge Amount |
32138 |
Total Medicare Allowed Amount |
21807.89 |
Total Medicare Payment Amount |
15830.84 |
Total Medicare Standardized Payment Amount |
16688.41 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
59 |
Number Of Beneficiaries Age Less65 |
91 |
Number Of Beneficiaries Age 65 to 74 |
22 |
Number Of Beneficiaries Age 75 to 84 |
25 |
Number Of Beneficiaries Age Greater 84 |
11 |
Number Of Female Beneficiaries |
104 |
Number Of Male Beneficiaries |
45 |
Number Of Non Hispanic White Beneficiaries |
90 |
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 |
45 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
104 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
44 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
49 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.7729 |