National Provider Identifier [NPI]: |
1750579660 |
Last Name Of The Provider |
PURNELL |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
401 E WATER ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
PONTIAC |
Zip Code Of The Provider |
617642023 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
5677 |
Number Of Medicare Beneficiaries |
329 |
Total Submitted Charge Amount |
333998 |
Total Medicare Allowed Amount |
217509.09 |
Total Medicare Payment Amount |
153441.15 |
Total Medicare Standardized Payment Amount |
157880.59 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
932 |
Number Of Medicare Beneficiaries With Drug Services |
172 |
Total Drug Submitted ChargeAmount |
22570 |
Total Drug Medicare AllowedAmount |
4077.81 |
Total Drug Medicare PaymentAmount |
3355.48 |
Total Drug Medicare Standardized Payment Amount |
3355.48 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
46 |
Number Of Medical Services |
4745 |
Number Of Medicare Beneficiaries With Medical Services |
329 |
Total Medical Submitted Charge Amount |
311428 |
Total Medical Medicare Allowed Amount |
213431.28 |
Total Medical Medicare Payment Amount |
150085.67 |
Total Medical Medicare Standardized Payment Amount |
154525.11 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
32 |
Number Of Beneficiaries Age 65 to 74 |
169 |
Number Of Beneficiaries Age 75 to 84 |
87 |
Number Of Beneficiaries Age Greater 84 |
41 |
Number Of Female Beneficiaries |
177 |
Number Of Male Beneficiaries |
152 |
Number Of Non Hispanic White Beneficiaries |
312 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
282 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
47 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
|
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
12 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
20 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
0.9197 |