National Provider Identifier [NPI]: |
1295753531 |
Last Name Of The Provider |
DODGE |
First Name Of The Provider |
JAIME |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2501 PIERCE ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SIOUX CITY |
Zip Code Of The Provider |
511043725 |
State Code Of The Provider |
IA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
147 |
Number Of Services |
3423 |
Number Of Medicare Beneficiaries |
504 |
Total Submitted Charge Amount |
286780.35 |
Total Medicare Allowed Amount |
147987.01 |
Total Medicare Payment Amount |
107721.11 |
Total Medicare Standardized Payment Amount |
117814.24 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
207 |
Number Of Medicare Beneficiaries With Drug Services |
85 |
Total Drug Submitted ChargeAmount |
2374 |
Total Drug Medicare AllowedAmount |
1263.12 |
Total Drug Medicare PaymentAmount |
1130.97 |
Total Drug Medicare Standardized Payment Amount |
1130.97 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
137 |
Number Of Medical Services |
3216 |
Number Of Medicare Beneficiaries With Medical Services |
504 |
Total Medical Submitted Charge Amount |
284406.35 |
Total Medical Medicare Allowed Amount |
146723.89 |
Total Medical Medicare Payment Amount |
106590.14 |
Total Medical Medicare Standardized Payment Amount |
116683.27 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
63 |
Number Of Beneficiaries Age 65 to 74 |
168 |
Number Of Beneficiaries Age 75 to 84 |
177 |
Number Of Beneficiaries Age Greater 84 |
96 |
Number Of Female Beneficiaries |
271 |
Number Of Male Beneficiaries |
233 |
Number Of Non Hispanic White Beneficiaries |
481 |
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 |
412 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
92 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
44 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.2064 |