National Provider Identifier [NPI]: |
1346247707 |
Last Name Of The Provider |
CICCONE |
First Name Of The Provider |
WILLIAM |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6011 E WOODMEN RD |
Street Address 2 Of The Provider |
SUITE 120 |
City Of The Provider |
COLORADO SPRINGS |
Zip Code Of The Provider |
809232603 |
State Code Of The Provider |
CO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
994 |
Number Of Medicare Beneficiaries |
44 |
Total Submitted Charge Amount |
70565.5 |
Total Medicare Allowed Amount |
22442.73 |
Total Medicare Payment Amount |
17007.76 |
Total Medicare Standardized Payment Amount |
16827.21 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
835 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
27993 |
Total Drug Medicare AllowedAmount |
10356.37 |
Total Drug Medicare PaymentAmount |
8119.4 |
Total Drug Medicare Standardized Payment Amount |
8119.4 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
159 |
Number Of Medicare Beneficiaries With Medical Services |
44 |
Total Medical Submitted Charge Amount |
42572.5 |
Total Medical Medicare Allowed Amount |
12086.36 |
Total Medical Medicare Payment Amount |
8888.36 |
Total Medical Medicare Standardized Payment Amount |
8707.81 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
21 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
26 |
Number Of Male Beneficiaries |
18 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
|
Percent Of With Alzheimers Disease or Dementia |
0 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
|
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
50 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
70 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2867 |