National Provider Identifier [NPI]: |
1114942596 |
Last Name Of The Provider |
PECK |
First Name Of The Provider |
DENNIS |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5702 N 26TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
TACOMA |
Zip Code Of The Provider |
984072406 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
658 |
Number Of Medicare Beneficiaries |
418 |
Total Submitted Charge Amount |
103666 |
Total Medicare Allowed Amount |
43268.78 |
Total Medicare Payment Amount |
27965.86 |
Total Medicare Standardized Payment Amount |
28637.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
56 |
Number Of Medicare Beneficiaries With Drug Services |
28 |
Total Drug Submitted ChargeAmount |
1068 |
Total Drug Medicare AllowedAmount |
469.46 |
Total Drug Medicare PaymentAmount |
449.52 |
Total Drug Medicare Standardized Payment Amount |
449.52 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
48 |
Number Of Medical Services |
602 |
Number Of Medicare Beneficiaries With Medical Services |
418 |
Total Medical Submitted Charge Amount |
102598 |
Total Medical Medicare Allowed Amount |
42799.32 |
Total Medical Medicare Payment Amount |
27516.34 |
Total Medical Medicare Standardized Payment Amount |
28188 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
49 |
Number Of Beneficiaries Age 65 to 74 |
150 |
Number Of Beneficiaries Age 75 to 84 |
120 |
Number Of Beneficiaries Age Greater 84 |
99 |
Number Of Female Beneficiaries |
270 |
Number Of Male Beneficiaries |
148 |
Number Of Non Hispanic White Beneficiaries |
371 |
Number Of Black or African American Beneficiaries |
22 |
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 |
351 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
67 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.0932 |