National Provider Identifier [NPI]: |
1740494913 |
Last Name Of The Provider |
CLEMENS |
First Name Of The Provider |
SETH |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
500 W BROADWAY ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
MISSOULA |
Zip Code Of The Provider |
598024008 |
State Code Of The Provider |
MT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pulmonary Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
42 |
Number Of Services |
2011 |
Number Of Medicare Beneficiaries |
539 |
Total Submitted Charge Amount |
356926.5 |
Total Medicare Allowed Amount |
174033.81 |
Total Medicare Payment Amount |
133062.58 |
Total Medicare Standardized Payment Amount |
130986.77 |
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 |
72 |
Number Of Beneficiaries Age Less65 |
75 |
Number Of Beneficiaries Age 65 to 74 |
245 |
Number Of Beneficiaries Age 75 to 84 |
167 |
Number Of Beneficiaries Age Greater 84 |
52 |
Number Of Female Beneficiaries |
257 |
Number Of Male Beneficiaries |
282 |
Number Of Non Hispanic White Beneficiaries |
503 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
22 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
435 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
104 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
19 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
35 |
Percent Of With Chronic Kidney Disease |
29 |
Percent Of With Chronic Obstructive Pulmonary Disease |
49 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
44 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.5283 |