National Provider Identifier [NPI]: |
1891750600 |
Last Name Of The Provider |
OCONNELL |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
979 CONGRESS PARK DRIVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
CENTERVILLE |
Zip Code Of The Provider |
454594009 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
37 |
Number Of Services |
1952 |
Number Of Medicare Beneficiaries |
344 |
Total Submitted Charge Amount |
212904 |
Total Medicare Allowed Amount |
121632.8 |
Total Medicare Payment Amount |
83884.28 |
Total Medicare Standardized Payment Amount |
87088.14 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
420 |
Number Of Medicare Beneficiaries With Drug Services |
112 |
Total Drug Submitted ChargeAmount |
14286 |
Total Drug Medicare AllowedAmount |
4821.58 |
Total Drug Medicare PaymentAmount |
4266.99 |
Total Drug Medicare Standardized Payment Amount |
4266.99 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
1532 |
Number Of Medicare Beneficiaries With Medical Services |
344 |
Total Medical Submitted Charge Amount |
198618 |
Total Medical Medicare Allowed Amount |
116811.22 |
Total Medical Medicare Payment Amount |
79617.29 |
Total Medical Medicare Standardized Payment Amount |
82821.15 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
22 |
Number Of Beneficiaries Age 65 to 74 |
190 |
Number Of Beneficiaries Age 75 to 84 |
99 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
162 |
Number Of Male Beneficiaries |
182 |
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 |
19 |
Number Of Beneficiaries With Medicare Only Entitlement |
324 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
20 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
0.771 |