National Provider Identifier [NPI]: |
1720043755 |
Last Name Of The Provider |
WILEY |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
305 HOSPITAL DR |
Street Address 2 Of The Provider |
SUITE 305 TATE CENTER |
City Of The Provider |
GLEN BURNIE |
Zip Code Of The Provider |
210615805 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pulmonary Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
2219 |
Number Of Medicare Beneficiaries |
525 |
Total Submitted Charge Amount |
269830 |
Total Medicare Allowed Amount |
240028.41 |
Total Medicare Payment Amount |
185414.32 |
Total Medicare Standardized Payment Amount |
179563.91 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
30 |
Number Of Medicare Beneficiaries With Drug Services |
25 |
Total Drug Submitted ChargeAmount |
1570 |
Total Drug Medicare AllowedAmount |
1236.8 |
Total Drug Medicare PaymentAmount |
1212.03 |
Total Drug Medicare Standardized Payment Amount |
1212.03 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
2189 |
Number Of Medicare Beneficiaries With Medical Services |
525 |
Total Medical Submitted Charge Amount |
268260 |
Total Medical Medicare Allowed Amount |
238791.61 |
Total Medical Medicare Payment Amount |
184202.29 |
Total Medical Medicare Standardized Payment Amount |
178351.88 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
63 |
Number Of Beneficiaries Age 65 to 74 |
218 |
Number Of Beneficiaries Age 75 to 84 |
173 |
Number Of Beneficiaries Age Greater 84 |
71 |
Number Of Female Beneficiaries |
300 |
Number Of Male Beneficiaries |
225 |
Number Of Non Hispanic White Beneficiaries |
465 |
Number Of Black or African American Beneficiaries |
42 |
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 |
465 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
60 |
Percent Of With Atrial Fibrillation |
28 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
19 |
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
51 |
Percent Of With Chronic Kidney Disease |
44 |
Percent Of With Chronic Obstructive Pulmonary Disease |
65 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
56 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
7 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
2.101 |