National Provider Identifier [NPI]: |
1538200498 |
Last Name Of The Provider |
HICKS |
First Name Of The Provider |
GREGORY |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
O.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2331 COLUMBUS AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANDUSKY |
Zip Code Of The Provider |
448704827 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Optometry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
4276 |
Number Of Medicare Beneficiaries |
466 |
Total Submitted Charge Amount |
129897 |
Total Medicare Allowed Amount |
117120.75 |
Total Medicare Payment Amount |
81343.76 |
Total Medicare Standardized Payment Amount |
91206.89 |
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 |
16 |
Number Of Medical Services |
4276 |
Number Of Medicare Beneficiaries With Medical Services |
466 |
Total Medical Submitted Charge Amount |
129897 |
Total Medical Medicare Allowed Amount |
117120.75 |
Total Medical Medicare Payment Amount |
81343.76 |
Total Medical Medicare Standardized Payment Amount |
91206.89 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
91 |
Number Of Beneficiaries Age 65 to 74 |
202 |
Number Of Beneficiaries Age 75 to 84 |
119 |
Number Of Beneficiaries Age Greater 84 |
54 |
Number Of Female Beneficiaries |
300 |
Number Of Male Beneficiaries |
166 |
Number Of Non Hispanic White Beneficiaries |
390 |
Number Of Black or African American Beneficiaries |
61 |
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 |
331 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
135 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
15 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.082 |