National Provider Identifier [NPI]: |
1043314164 |
Last Name Of The Provider |
GONTE |
First Name Of The Provider |
WILLIAM |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
29877 TELEGRAPH |
Street Address 2 Of The Provider |
STE 401 |
City Of The Provider |
SOUTHFIELD |
Zip Code Of The Provider |
48034 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
198 |
Number Of Medicare Beneficiaries |
101 |
Total Submitted Charge Amount |
35385 |
Total Medicare Allowed Amount |
26726.22 |
Total Medicare Payment Amount |
20384.33 |
Total Medicare Standardized Payment Amount |
19831.49 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
495 |
Total Drug Medicare AllowedAmount |
274.36 |
Total Drug Medicare PaymentAmount |
268.85 |
Total Drug Medicare Standardized Payment Amount |
268.85 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
17 |
Number Of Medical Services |
183 |
Number Of Medicare Beneficiaries With Medical Services |
101 |
Total Medical Submitted Charge Amount |
34890 |
Total Medical Medicare Allowed Amount |
26451.86 |
Total Medical Medicare Payment Amount |
20115.48 |
Total Medical Medicare Standardized Payment Amount |
19562.64 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
45 |
Number Of Beneficiaries Age 75 to 84 |
29 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
55 |
Number Of Male Beneficiaries |
46 |
Number Of Non Hispanic White Beneficiaries |
59 |
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 |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
15 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0037 |