National Provider Identifier [NPI]: |
1134380132 |
Last Name Of The Provider |
LIM |
First Name Of The Provider |
ADRIANUS |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2142 N COVE BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
TOLEDO |
Zip Code Of The Provider |
436063895 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
77 |
Number Of Services |
383 |
Number Of Medicare Beneficiaries |
257 |
Total Submitted Charge Amount |
408500 |
Total Medicare Allowed Amount |
63497.68 |
Total Medicare Payment Amount |
49607.08 |
Total Medicare Standardized Payment Amount |
47277.36 |
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 |
77 |
Number Of Medical Services |
383 |
Number Of Medicare Beneficiaries With Medical Services |
257 |
Total Medical Submitted Charge Amount |
408500 |
Total Medical Medicare Allowed Amount |
63497.68 |
Total Medical Medicare Payment Amount |
49607.08 |
Total Medical Medicare Standardized Payment Amount |
47277.36 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
88 |
Number Of Beneficiaries Age 75 to 84 |
71 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
139 |
Number Of Male Beneficiaries |
118 |
Number Of Non Hispanic White Beneficiaries |
189 |
Number Of Black or African American Beneficiaries |
54 |
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 |
172 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
85 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
50 |
Percent Of With Chronic Kidney Disease |
51 |
Percent Of With Chronic Obstructive Pulmonary Disease |
46 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
70 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
57 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.3275 |