National Provider Identifier [NPI]: |
1114032372 |
Last Name Of The Provider |
DWYER |
First Name Of The Provider |
THOMAS |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
D.P.M. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1952 ABERDEEN CT |
Street Address 2 Of The Provider |
|
City Of The Provider |
SYCAMORE |
Zip Code Of The Provider |
601783175 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Podiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
3597 |
Number Of Medicare Beneficiaries |
604 |
Total Submitted Charge Amount |
532603 |
Total Medicare Allowed Amount |
152155.14 |
Total Medicare Payment Amount |
109673.98 |
Total Medicare Standardized Payment Amount |
115210.72 |
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 |
37 |
Number Of Medical Services |
3597 |
Number Of Medicare Beneficiaries With Medical Services |
604 |
Total Medical Submitted Charge Amount |
532603 |
Total Medical Medicare Allowed Amount |
152155.14 |
Total Medical Medicare Payment Amount |
109673.98 |
Total Medical Medicare Standardized Payment Amount |
115210.72 |
Average Age Of Beneficiaries |
79 |
Number Of Beneficiaries Age Less65 |
61 |
Number Of Beneficiaries Age 65 to 74 |
149 |
Number Of Beneficiaries Age 75 to 84 |
179 |
Number Of Beneficiaries Age Greater 84 |
215 |
Number Of Female Beneficiaries |
370 |
Number Of Male Beneficiaries |
234 |
Number Of Non Hispanic White Beneficiaries |
578 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
12 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
421 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
183 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
59 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.9512 |