National Provider Identifier [NPI]: |
1093747743 |
Last Name Of The Provider |
CALL |
First Name Of The Provider |
JEFFREY |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4403 HARRISON BLVD |
Street Address 2 Of The Provider |
STE 3875 |
City Of The Provider |
OGDEN |
Zip Code Of The Provider |
844033271 |
State Code Of The Provider |
UT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
49 |
Number Of Services |
9447 |
Number Of Medicare Beneficiaries |
757 |
Total Submitted Charge Amount |
425708 |
Total Medicare Allowed Amount |
280249.86 |
Total Medicare Payment Amount |
197002.4 |
Total Medicare Standardized Payment Amount |
206248.51 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
3210 |
Number Of Medicare Beneficiaries With Drug Services |
289 |
Total Drug Submitted ChargeAmount |
76910 |
Total Drug Medicare AllowedAmount |
44812.71 |
Total Drug Medicare PaymentAmount |
35337.42 |
Total Drug Medicare Standardized Payment Amount |
35337.42 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
37 |
Number Of Medical Services |
6237 |
Number Of Medicare Beneficiaries With Medical Services |
757 |
Total Medical Submitted Charge Amount |
348798 |
Total Medical Medicare Allowed Amount |
235437.15 |
Total Medical Medicare Payment Amount |
161664.98 |
Total Medical Medicare Standardized Payment Amount |
170911.09 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
267 |
Number Of Beneficiaries Age 75 to 84 |
312 |
Number Of Beneficiaries Age Greater 84 |
149 |
Number Of Female Beneficiaries |
427 |
Number Of Male Beneficiaries |
330 |
Number Of Non Hispanic White Beneficiaries |
726 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
16 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
742 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
15 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.0872 |