National Provider Identifier [NPI]: |
1457633075 |
Last Name Of The Provider |
DOW |
First Name Of The Provider |
AGATA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
22101 MOROSS RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
DETROIT |
Zip Code Of The Provider |
482362148 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
775 |
Number Of Medicare Beneficiaries |
697 |
Total Submitted Charge Amount |
760904 |
Total Medicare Allowed Amount |
131378.06 |
Total Medicare Payment Amount |
100716.65 |
Total Medicare Standardized Payment Amount |
96483.53 |
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 |
17 |
Number Of Medical Services |
775 |
Number Of Medicare Beneficiaries With Medical Services |
697 |
Total Medical Submitted Charge Amount |
760904 |
Total Medical Medicare Allowed Amount |
131378.06 |
Total Medical Medicare Payment Amount |
100716.65 |
Total Medical Medicare Standardized Payment Amount |
96483.53 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
242 |
Number Of Beneficiaries Age 65 to 74 |
167 |
Number Of Beneficiaries Age 75 to 84 |
155 |
Number Of Beneficiaries Age Greater 84 |
133 |
Number Of Female Beneficiaries |
399 |
Number Of Male Beneficiaries |
298 |
Number Of Non Hispanic White Beneficiaries |
569 |
Number Of Black or African American Beneficiaries |
90 |
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 |
436 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
261 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
50 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
48 |
Percent Of With Depression |
44 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
67 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
55 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.3515 |