National Provider Identifier [NPI]: |
1407955008 |
Last Name Of The Provider |
ZACK |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4841 MONROE ST |
Street Address 2 Of The Provider |
SUITE 110 |
City Of The Provider |
TOLEDO |
Zip Code Of The Provider |
436234385 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
48 |
Number Of Services |
1130 |
Number Of Medicare Beneficiaries |
551 |
Total Submitted Charge Amount |
488234 |
Total Medicare Allowed Amount |
138227.67 |
Total Medicare Payment Amount |
104526.98 |
Total Medicare Standardized Payment Amount |
106295.36 |
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 |
48 |
Number Of Medical Services |
1130 |
Number Of Medicare Beneficiaries With Medical Services |
551 |
Total Medical Submitted Charge Amount |
488234 |
Total Medical Medicare Allowed Amount |
138227.67 |
Total Medical Medicare Payment Amount |
104526.98 |
Total Medical Medicare Standardized Payment Amount |
106295.36 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
114 |
Number Of Beneficiaries Age 65 to 74 |
254 |
Number Of Beneficiaries Age 75 to 84 |
132 |
Number Of Beneficiaries Age Greater 84 |
51 |
Number Of Female Beneficiaries |
302 |
Number Of Male Beneficiaries |
249 |
Number Of Non Hispanic White Beneficiaries |
442 |
Number Of Black or African American Beneficiaries |
78 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
17 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
398 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
153 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
28 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
44 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.7914 |