National Provider Identifier [NPI]: |
1598791113 |
Last Name Of The Provider |
JAWDAT |
First Name Of The Provider |
IMTIHAN |
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 |
6624 FANNIN ST |
Street Address 2 Of The Provider |
STE. 1590 |
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770302312 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
51 |
Number Of Services |
2052 |
Number Of Medicare Beneficiaries |
177 |
Total Submitted Charge Amount |
803865 |
Total Medicare Allowed Amount |
277130.78 |
Total Medicare Payment Amount |
205650.88 |
Total Medicare Standardized Payment Amount |
214965.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
56 |
Number Of Medicare Beneficiaries With Drug Services |
14 |
Total Drug Submitted ChargeAmount |
5880 |
Total Drug Medicare AllowedAmount |
2962.63 |
Total Drug Medicare PaymentAmount |
2065.67 |
Total Drug Medicare Standardized Payment Amount |
2065.67 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
50 |
Number Of Medical Services |
1996 |
Number Of Medicare Beneficiaries With Medical Services |
177 |
Total Medical Submitted Charge Amount |
797985 |
Total Medical Medicare Allowed Amount |
274168.15 |
Total Medical Medicare Payment Amount |
203585.21 |
Total Medical Medicare Standardized Payment Amount |
212899.99 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
83 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
100 |
Number Of Male Beneficiaries |
77 |
Number Of Non Hispanic White Beneficiaries |
110 |
Number Of Black or African American Beneficiaries |
38 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
17 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
139 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
38 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
32 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
49 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
60 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.8494 |