National Provider Identifier [NPI]: |
1295822872 |
Last Name Of The Provider |
KNOEDLER |
First Name Of The Provider |
DARLY |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8901 W LINCOLN AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MILWAUKEE |
Zip Code Of The Provider |
532272409 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pathology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
2315 |
Number Of Medicare Beneficiaries |
797 |
Total Submitted Charge Amount |
565994 |
Total Medicare Allowed Amount |
81690.99 |
Total Medicare Payment Amount |
62924.31 |
Total Medicare Standardized Payment Amount |
48926.05 |
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 |
24 |
Number Of Medical Services |
2315 |
Number Of Medicare Beneficiaries With Medical Services |
797 |
Total Medical Submitted Charge Amount |
565994 |
Total Medical Medicare Allowed Amount |
81690.99 |
Total Medical Medicare Payment Amount |
62924.31 |
Total Medical Medicare Standardized Payment Amount |
48926.05 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
124 |
Number Of Beneficiaries Age 65 to 74 |
382 |
Number Of Beneficiaries Age 75 to 84 |
219 |
Number Of Beneficiaries Age Greater 84 |
72 |
Number Of Female Beneficiaries |
414 |
Number Of Male Beneficiaries |
383 |
Number Of Non Hispanic White Beneficiaries |
717 |
Number Of Black or African American Beneficiaries |
38 |
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 |
18 |
Number Of Beneficiaries With Medicare Only Entitlement |
629 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
168 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
21 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.5469 |