National Provider Identifier [NPI]: |
1588757710 |
Last Name Of The Provider |
FERTIKH |
First Name Of The Provider |
DJAMIL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8001 FORBES PL |
Street Address 2 Of The Provider |
SUITE 103 |
City Of The Provider |
SPRINGFIELD |
Zip Code Of The Provider |
221512208 |
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 |
159 |
Number Of Services |
6374 |
Number Of Medicare Beneficiaries |
4041 |
Total Submitted Charge Amount |
1191927 |
Total Medicare Allowed Amount |
252871.06 |
Total Medicare Payment Amount |
195035.75 |
Total Medicare Standardized Payment Amount |
182365.45 |
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 |
159 |
Number Of Medical Services |
6374 |
Number Of Medicare Beneficiaries With Medical Services |
4041 |
Total Medical Submitted Charge Amount |
1191927 |
Total Medical Medicare Allowed Amount |
252871.06 |
Total Medical Medicare Payment Amount |
195035.75 |
Total Medical Medicare Standardized Payment Amount |
182365.45 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
471 |
Number Of Beneficiaries Age 65 to 74 |
1518 |
Number Of Beneficiaries Age 75 to 84 |
1222 |
Number Of Beneficiaries Age Greater 84 |
830 |
Number Of Female Beneficiaries |
2466 |
Number Of Male Beneficiaries |
1575 |
Number Of Non Hispanic White Beneficiaries |
2790 |
Number Of Black or African American Beneficiaries |
725 |
Number Of AsianPacific Islander Beneficiaries |
227 |
Number Of Hispanic Beneficiaries |
194 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
3349 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
692 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
1.522 |