National Provider Identifier [NPI]: |
1275695025 |
Last Name Of The Provider |
COLES |
First Name Of The Provider |
DESTIN |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
O.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
421 DEMERS AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
EAST GRAND FORKS |
Zip Code Of The Provider |
567211835 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Optometry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
10 |
Number Of Services |
1036 |
Number Of Medicare Beneficiaries |
178 |
Total Submitted Charge Amount |
42615 |
Total Medicare Allowed Amount |
29979.43 |
Total Medicare Payment Amount |
20503.3 |
Total Medicare Standardized Payment Amount |
20885.33 |
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 |
10 |
Number Of Medical Services |
1036 |
Number Of Medicare Beneficiaries With Medical Services |
178 |
Total Medical Submitted Charge Amount |
42615 |
Total Medical Medicare Allowed Amount |
29979.43 |
Total Medical Medicare Payment Amount |
20503.3 |
Total Medical Medicare Standardized Payment Amount |
20885.33 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
60 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
88 |
Number Of Male Beneficiaries |
90 |
Number Of Non Hispanic White Beneficiaries |
150 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
15 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
86 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
92 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
34 |
Percent Of With Hypertension |
42 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0802 |