National Provider Identifier [NPI]: |
1467671677 |
Last Name Of The Provider |
KHALIQ |
First Name Of The Provider |
FAZILA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7601 SOUTHCREST PARKWAY |
Street Address 2 Of The Provider |
|
City Of The Provider |
SOUTHAVEN |
Zip Code Of The Provider |
38671 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
1484 |
Number Of Medicare Beneficiaries |
532 |
Total Submitted Charge Amount |
182527 |
Total Medicare Allowed Amount |
123783.2 |
Total Medicare Payment Amount |
96850.95 |
Total Medicare Standardized Payment Amount |
102115.39 |
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 |
14 |
Number Of Medical Services |
1484 |
Number Of Medicare Beneficiaries With Medical Services |
532 |
Total Medical Submitted Charge Amount |
182527 |
Total Medical Medicare Allowed Amount |
123783.2 |
Total Medical Medicare Payment Amount |
96850.95 |
Total Medical Medicare Standardized Payment Amount |
102115.39 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
110 |
Number Of Beneficiaries Age 65 to 74 |
139 |
Number Of Beneficiaries Age 75 to 84 |
171 |
Number Of Beneficiaries Age Greater 84 |
112 |
Number Of Female Beneficiaries |
314 |
Number Of Male Beneficiaries |
218 |
Number Of Non Hispanic White Beneficiaries |
387 |
Number Of Black or African American Beneficiaries |
|
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 |
310 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
222 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
29 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
62 |
Percent Of With Chronic Kidney Disease |
64 |
Percent Of With Chronic Obstructive Pulmonary Disease |
41 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
65 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
15 |
Percent Of With Stroke |
21 |
Average HCC Risk Score Of Beneficiaries |
2.5434 |