National Provider Identifier [NPI]: |
1841275252 |
Last Name Of The Provider |
O'BRIEN |
First Name Of The Provider |
JAMES |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
353 MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
MANCHESTER |
Zip Code Of The Provider |
060404145 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
790 |
Number Of Medicare Beneficiaries |
433 |
Total Submitted Charge Amount |
703200 |
Total Medicare Allowed Amount |
158922.5 |
Total Medicare Payment Amount |
123706.09 |
Total Medicare Standardized Payment Amount |
118791.64 |
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 |
31 |
Number Of Medical Services |
790 |
Number Of Medicare Beneficiaries With Medical Services |
433 |
Total Medical Submitted Charge Amount |
703200 |
Total Medical Medicare Allowed Amount |
158922.5 |
Total Medical Medicare Payment Amount |
123706.09 |
Total Medical Medicare Standardized Payment Amount |
118791.64 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
211 |
Number Of Beneficiaries Age 75 to 84 |
149 |
Number Of Beneficiaries Age Greater 84 |
36 |
Number Of Female Beneficiaries |
234 |
Number Of Male Beneficiaries |
199 |
Number Of Non Hispanic White Beneficiaries |
403 |
Number Of Black or African American Beneficiaries |
|
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 |
11 |
Number Of Beneficiaries With Medicare Only Entitlement |
360 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
73 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.1884 |