National Provider Identifier [NPI]: |
1659583755 |
Last Name Of The Provider |
JONES |
First Name Of The Provider |
BRETT |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1740 W TAYLOR ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606127232 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
21 |
Number Of Services |
606 |
Number Of Medicare Beneficiaries |
547 |
Total Submitted Charge Amount |
395963 |
Total Medicare Allowed Amount |
97206.59 |
Total Medicare Payment Amount |
72037.3 |
Total Medicare Standardized Payment Amount |
72120.4 |
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 |
21 |
Number Of Medical Services |
606 |
Number Of Medicare Beneficiaries With Medical Services |
547 |
Total Medical Submitted Charge Amount |
395963 |
Total Medical Medicare Allowed Amount |
97206.59 |
Total Medical Medicare Payment Amount |
72037.3 |
Total Medical Medicare Standardized Payment Amount |
72120.4 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
151 |
Number Of Beneficiaries Age 65 to 74 |
156 |
Number Of Beneficiaries Age 75 to 84 |
139 |
Number Of Beneficiaries Age Greater 84 |
101 |
Number Of Female Beneficiaries |
300 |
Number Of Male Beneficiaries |
247 |
Number Of Non Hispanic White Beneficiaries |
481 |
Number Of Black or African American Beneficiaries |
55 |
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 |
348 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
199 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
38 |
Percent Of With Chronic Kidney Disease |
41 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
58 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
16 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.0636 |