National Provider Identifier [NPI]: |
1255333282 |
Last Name Of The Provider |
ZIVKOVIC |
First Name Of The Provider |
DEJAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MS |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
850 COLUMBIA RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
WESTLAKE |
Zip Code Of The Provider |
441451493 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiologist Assistants |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
46 |
Number Of Services |
136 |
Number Of Medicare Beneficiaries |
130 |
Total Submitted Charge Amount |
195613.03 |
Total Medicare Allowed Amount |
19140.85 |
Total Medicare Payment Amount |
14783.9 |
Total Medicare Standardized Payment Amount |
15110.43 |
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 |
46 |
Number Of Medical Services |
136 |
Number Of Medicare Beneficiaries With Medical Services |
130 |
Total Medical Submitted Charge Amount |
195613.03 |
Total Medical Medicare Allowed Amount |
19140.85 |
Total Medical Medicare Payment Amount |
14783.9 |
Total Medical Medicare Standardized Payment Amount |
15110.43 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
58 |
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
69 |
Number Of Male Beneficiaries |
61 |
Number Of Non Hispanic White Beneficiaries |
118 |
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 |
104 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
26 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
35 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
57 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.0927 |