National Provider Identifier [NPI]: |
1679505382 |
Last Name Of The Provider |
WUNDERLICH |
First Name Of The Provider |
CARYN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1400 DOWELL SPRINGS BLVD |
Street Address 2 Of The Provider |
STE 200 |
City Of The Provider |
KNOXVILLE |
Zip Code Of The Provider |
379092456 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
7188 |
Number Of Medicare Beneficiaries |
1513 |
Total Submitted Charge Amount |
1323310.1 |
Total Medicare Allowed Amount |
417637.9 |
Total Medicare Payment Amount |
349363.23 |
Total Medicare Standardized Payment Amount |
385846.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
2904 |
Number Of Medicare Beneficiaries With Drug Services |
207 |
Total Drug Submitted ChargeAmount |
8092.1 |
Total Drug Medicare AllowedAmount |
3622.88 |
Total Drug Medicare PaymentAmount |
2806.09 |
Total Drug Medicare Standardized Payment Amount |
2806.09 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
4284 |
Number Of Medicare Beneficiaries With Medical Services |
1512 |
Total Medical Submitted Charge Amount |
1315218 |
Total Medical Medicare Allowed Amount |
414015.02 |
Total Medical Medicare Payment Amount |
346557.14 |
Total Medical Medicare Standardized Payment Amount |
383040.43 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
123 |
Number Of Beneficiaries Age 65 to 74 |
962 |
Number Of Beneficiaries Age 75 to 84 |
373 |
Number Of Beneficiaries Age Greater 84 |
55 |
Number Of Female Beneficiaries |
|
Number Of Male Beneficiaries |
|
Number Of Non Hispanic White Beneficiaries |
1444 |
Number Of Black or African American Beneficiaries |
45 |
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 |
1404 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
109 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
4 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
6 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
1 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
0.7451 |