National Provider Identifier [NPI]: |
1821027202 |
Last Name Of The Provider |
FOSS |
First Name Of The Provider |
JEFFREY |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2514 BERT KOUNS LOOP |
Street Address 2 Of The Provider |
SUITE 6 |
City Of The Provider |
SHREVEPORT |
Zip Code Of The Provider |
711183146 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
13 |
Number Of Services |
610 |
Number Of Medicare Beneficiaries |
408 |
Total Submitted Charge Amount |
269796 |
Total Medicare Allowed Amount |
60840.36 |
Total Medicare Payment Amount |
47027.25 |
Total Medicare Standardized Payment Amount |
48366.64 |
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 |
13 |
Number Of Medical Services |
610 |
Number Of Medicare Beneficiaries With Medical Services |
408 |
Total Medical Submitted Charge Amount |
269796 |
Total Medical Medicare Allowed Amount |
60840.36 |
Total Medical Medicare Payment Amount |
47027.25 |
Total Medical Medicare Standardized Payment Amount |
48366.64 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
106 |
Number Of Beneficiaries Age 65 to 74 |
125 |
Number Of Beneficiaries Age 75 to 84 |
111 |
Number Of Beneficiaries Age Greater 84 |
66 |
Number Of Female Beneficiaries |
209 |
Number Of Male Beneficiaries |
199 |
Number Of Non Hispanic White Beneficiaries |
317 |
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 |
210 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
198 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
32 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
44 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.5957 |