National Provider Identifier [NPI]: |
1114972387 |
Last Name Of The Provider |
REILLY |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8629 SUDLEY RD |
Street Address 2 Of The Provider |
SUITE 102 |
City Of The Provider |
MANASSAS |
Zip Code Of The Provider |
201104590 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
163 |
Number Of Services |
4215 |
Number Of Medicare Beneficiaries |
2804 |
Total Submitted Charge Amount |
654380 |
Total Medicare Allowed Amount |
128025.68 |
Total Medicare Payment Amount |
93563.75 |
Total Medicare Standardized Payment Amount |
96695.89 |
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 |
163 |
Number Of Medical Services |
4215 |
Number Of Medicare Beneficiaries With Medical Services |
2804 |
Total Medical Submitted Charge Amount |
654380 |
Total Medical Medicare Allowed Amount |
128025.68 |
Total Medical Medicare Payment Amount |
93563.75 |
Total Medical Medicare Standardized Payment Amount |
96695.89 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
352 |
Number Of Beneficiaries Age 65 to 74 |
1148 |
Number Of Beneficiaries Age 75 to 84 |
857 |
Number Of Beneficiaries Age Greater 84 |
447 |
Number Of Female Beneficiaries |
1724 |
Number Of Male Beneficiaries |
1080 |
Number Of Non Hispanic White Beneficiaries |
2374 |
Number Of Black or African American Beneficiaries |
314 |
Number Of AsianPacific Islander Beneficiaries |
38 |
Number Of Hispanic Beneficiaries |
46 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
2276 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
528 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.5527 |