National Provider Identifier [NPI]: |
1396816005 |
Last Name Of The Provider |
JOSEPH |
First Name Of The Provider |
ANDRE |
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 |
1708 S YAKIMA AVE |
Street Address 2 Of The Provider |
SUITE #40 |
City Of The Provider |
TACOMA |
Zip Code Of The Provider |
98405 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
42 |
Number Of Services |
202 |
Number Of Medicare Beneficiaries |
112 |
Total Submitted Charge Amount |
147225 |
Total Medicare Allowed Amount |
52895.75 |
Total Medicare Payment Amount |
39252.44 |
Total Medicare Standardized Payment Amount |
41545.24 |
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 |
42 |
Number Of Medical Services |
202 |
Number Of Medicare Beneficiaries With Medical Services |
112 |
Total Medical Submitted Charge Amount |
147225 |
Total Medical Medicare Allowed Amount |
52895.75 |
Total Medical Medicare Payment Amount |
39252.44 |
Total Medical Medicare Standardized Payment Amount |
41545.24 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
50 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
53 |
Number Of Male Beneficiaries |
59 |
Number Of Non Hispanic White Beneficiaries |
86 |
Number Of Black or African American Beneficiaries |
|
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 |
82 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
30 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
14 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.5859 |