National Provider Identifier [NPI]: |
1154462380 |
Last Name Of The Provider |
SAREMIAN |
First Name Of The Provider |
JINOUS |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
655 W 8TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
JACKSONVILLE |
Zip Code Of The Provider |
322096511 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pathology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
741 |
Number Of Medicare Beneficiaries |
260 |
Total Submitted Charge Amount |
121822 |
Total Medicare Allowed Amount |
28640.47 |
Total Medicare Payment Amount |
21473.26 |
Total Medicare Standardized Payment Amount |
17885.93 |
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 |
23 |
Number Of Medical Services |
741 |
Number Of Medicare Beneficiaries With Medical Services |
260 |
Total Medical Submitted Charge Amount |
121822 |
Total Medical Medicare Allowed Amount |
28640.47 |
Total Medical Medicare Payment Amount |
21473.26 |
Total Medical Medicare Standardized Payment Amount |
17885.93 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
115 |
Number Of Beneficiaries Age 65 to 74 |
108 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
139 |
Number Of Male Beneficiaries |
121 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
133 |
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 |
93 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
167 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
73 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.185 |