National Provider Identifier [NPI]: |
1376657080 |
Last Name Of The Provider |
DAOUD |
First Name Of The Provider |
IBRAHIM |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
95 WOODLAND ST FL 2 |
Street Address 2 Of The Provider |
|
City Of The Provider |
HARTFORD |
Zip Code Of The Provider |
061051230 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
69 |
Number Of Services |
680 |
Number Of Medicare Beneficiaries |
308 |
Total Submitted Charge Amount |
644762 |
Total Medicare Allowed Amount |
193984.48 |
Total Medicare Payment Amount |
149550.44 |
Total Medicare Standardized Payment Amount |
140023.76 |
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 |
69 |
Number Of Medical Services |
680 |
Number Of Medicare Beneficiaries With Medical Services |
308 |
Total Medical Submitted Charge Amount |
644762 |
Total Medical Medicare Allowed Amount |
193984.48 |
Total Medical Medicare Payment Amount |
149550.44 |
Total Medical Medicare Standardized Payment Amount |
140023.76 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
30 |
Number Of Beneficiaries Age 65 to 74 |
127 |
Number Of Beneficiaries Age 75 to 84 |
101 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
167 |
Number Of Male Beneficiaries |
141 |
Number Of Non Hispanic White Beneficiaries |
262 |
Number Of Black or African American Beneficiaries |
23 |
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 |
241 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
67 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.3753 |