National Provider Identifier [NPI]: |
1265412563 |
Last Name Of The Provider |
CLENDENIN |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1020 REELFOOT AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
UNION CITY |
Zip Code Of The Provider |
38261 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
115 |
Number Of Services |
3764 |
Number Of Medicare Beneficiaries |
409 |
Total Submitted Charge Amount |
240149 |
Total Medicare Allowed Amount |
140315.14 |
Total Medicare Payment Amount |
99121.14 |
Total Medicare Standardized Payment Amount |
111275.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
578 |
Number Of Medicare Beneficiaries With Drug Services |
191 |
Total Drug Submitted ChargeAmount |
12605 |
Total Drug Medicare AllowedAmount |
6897.12 |
Total Drug Medicare PaymentAmount |
6360.18 |
Total Drug Medicare Standardized Payment Amount |
6360.18 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
101 |
Number Of Medical Services |
3186 |
Number Of Medicare Beneficiaries With Medical Services |
409 |
Total Medical Submitted Charge Amount |
227544 |
Total Medical Medicare Allowed Amount |
133418.02 |
Total Medical Medicare Payment Amount |
92760.96 |
Total Medical Medicare Standardized Payment Amount |
104915.48 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
229 |
Number Of Beneficiaries Age 75 to 84 |
118 |
Number Of Beneficiaries Age Greater 84 |
35 |
Number Of Female Beneficiaries |
225 |
Number Of Male Beneficiaries |
184 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
377 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
32 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9829 |