National Provider Identifier [NPI]: |
1417115452 |
Last Name Of The Provider |
PREAS |
First Name Of The Provider |
STEPHEN |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2430 TUCKER DR |
Street Address 2 Of The Provider |
BLDG A |
City Of The Provider |
LOGANVILLE |
Zip Code Of The Provider |
300524390 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
9 |
Number Of Services |
1209 |
Number Of Medicare Beneficiaries |
318 |
Total Submitted Charge Amount |
85881 |
Total Medicare Allowed Amount |
76978.24 |
Total Medicare Payment Amount |
59511 |
Total Medicare Standardized Payment Amount |
62522.68 |
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 |
9 |
Number Of Medical Services |
1209 |
Number Of Medicare Beneficiaries With Medical Services |
318 |
Total Medical Submitted Charge Amount |
85881 |
Total Medical Medicare Allowed Amount |
76978.24 |
Total Medical Medicare Payment Amount |
59511 |
Total Medical Medicare Standardized Payment Amount |
62522.68 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
62 |
Number Of Beneficiaries Age 65 to 74 |
103 |
Number Of Beneficiaries Age 75 to 84 |
89 |
Number Of Beneficiaries Age Greater 84 |
64 |
Number Of Female Beneficiaries |
194 |
Number Of Male Beneficiaries |
124 |
Number Of Non Hispanic White Beneficiaries |
236 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
75 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
65 |
Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
44 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
45 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.2734 |