National Provider Identifier [NPI]: |
1164621736 |
Last Name Of The Provider |
MANN |
First Name Of The Provider |
DARIN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
OAKWOOD SOUTHSHORE MEDICAL CENTER |
Street Address 2 Of The Provider |
5450 FORT ST |
City Of The Provider |
TRENTON |
Zip Code Of The Provider |
48183 |
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 |
25 |
Number Of Services |
985 |
Number Of Medicare Beneficiaries |
639 |
Total Submitted Charge Amount |
609143 |
Total Medicare Allowed Amount |
116137.4 |
Total Medicare Payment Amount |
89744.22 |
Total Medicare Standardized Payment Amount |
87850.89 |
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 |
25 |
Number Of Medical Services |
985 |
Number Of Medicare Beneficiaries With Medical Services |
639 |
Total Medical Submitted Charge Amount |
609143 |
Total Medical Medicare Allowed Amount |
116137.4 |
Total Medical Medicare Payment Amount |
89744.22 |
Total Medical Medicare Standardized Payment Amount |
87850.89 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
185 |
Number Of Beneficiaries Age 65 to 74 |
215 |
Number Of Beneficiaries Age 75 to 84 |
152 |
Number Of Beneficiaries Age Greater 84 |
87 |
Number Of Female Beneficiaries |
384 |
Number Of Male Beneficiaries |
255 |
Number Of Non Hispanic White Beneficiaries |
364 |
Number Of Black or African American Beneficiaries |
255 |
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 |
444 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
195 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
29 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
46 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.01 |