National Provider Identifier [NPI]: |
1437146180 |
Last Name Of The Provider |
LI |
First Name Of The Provider |
INA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1401 FOULK RD |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
WILMINGTON |
Zip Code Of The Provider |
198032763 |
State Code Of The Provider |
DE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
33 |
Number Of Services |
914 |
Number Of Medicare Beneficiaries |
295 |
Total Submitted Charge Amount |
135889.5 |
Total Medicare Allowed Amount |
77565.59 |
Total Medicare Payment Amount |
58110.06 |
Total Medicare Standardized Payment Amount |
57403.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
55 |
Number Of Medicare Beneficiaries With Drug Services |
42 |
Total Drug Submitted ChargeAmount |
6523.5 |
Total Drug Medicare AllowedAmount |
3008.88 |
Total Drug Medicare PaymentAmount |
2948.6 |
Total Drug Medicare Standardized Payment Amount |
2948.6 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
859 |
Number Of Medicare Beneficiaries With Medical Services |
295 |
Total Medical Submitted Charge Amount |
129366 |
Total Medical Medicare Allowed Amount |
74556.71 |
Total Medical Medicare Payment Amount |
55161.46 |
Total Medical Medicare Standardized Payment Amount |
54454.55 |
Average Age Of Beneficiaries |
78 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
61 |
Number Of Beneficiaries Age 75 to 84 |
98 |
Number Of Beneficiaries Age Greater 84 |
95 |
Number Of Female Beneficiaries |
205 |
Number Of Male Beneficiaries |
90 |
Number Of Non Hispanic White Beneficiaries |
136 |
Number Of Black or African American Beneficiaries |
125 |
Number Of AsianPacific Islander Beneficiaries |
22 |
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 |
178 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
117 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
41 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
39 |
Percent Of With Chronic Kidney Disease |
46 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
47 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
2.4066 |