National Provider Identifier [NPI]: |
1043286313 |
Last Name Of The Provider |
PORUBSKY |
First Name Of The Provider |
EDWARD |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
340 N BELAIR RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
EVANS |
Zip Code Of The Provider |
308093000 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Otolaryngology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
99 |
Number Of Services |
5732 |
Number Of Medicare Beneficiaries |
861 |
Total Submitted Charge Amount |
1062300 |
Total Medicare Allowed Amount |
275897.75 |
Total Medicare Payment Amount |
199092.68 |
Total Medicare Standardized Payment Amount |
208135.76 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
160 |
Number Of Medicare Beneficiaries With Drug Services |
33 |
Total Drug Submitted ChargeAmount |
1320 |
Total Drug Medicare AllowedAmount |
252.2 |
Total Drug Medicare PaymentAmount |
176.64 |
Total Drug Medicare Standardized Payment Amount |
176.64 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
97 |
Number Of Medical Services |
5572 |
Number Of Medicare Beneficiaries With Medical Services |
861 |
Total Medical Submitted Charge Amount |
1060980 |
Total Medical Medicare Allowed Amount |
275645.55 |
Total Medical Medicare Payment Amount |
198916.04 |
Total Medical Medicare Standardized Payment Amount |
207959.12 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
115 |
Number Of Beneficiaries Age 65 to 74 |
443 |
Number Of Beneficiaries Age 75 to 84 |
238 |
Number Of Beneficiaries Age Greater 84 |
65 |
Number Of Female Beneficiaries |
544 |
Number Of Male Beneficiaries |
317 |
Number Of Non Hispanic White Beneficiaries |
693 |
Number Of Black or African American Beneficiaries |
155 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
758 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
103 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.0121 |