National Provider Identifier [NPI]: |
1093943086 |
Last Name Of The Provider |
CARLSON |
First Name Of The Provider |
JOSHUA |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2859 STATE ST STE 103 |
Street Address 2 Of The Provider |
|
City Of The Provider |
MEDFORD |
Zip Code Of The Provider |
975048495 |
State Code Of The Provider |
OR |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
26 |
Number Of Services |
127 |
Number Of Medicare Beneficiaries |
107 |
Total Submitted Charge Amount |
514890 |
Total Medicare Allowed Amount |
23997 |
Total Medicare Payment Amount |
18568.06 |
Total Medicare Standardized Payment Amount |
20401.73 |
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 |
26 |
Number Of Medical Services |
127 |
Number Of Medicare Beneficiaries With Medical Services |
107 |
Total Medical Submitted Charge Amount |
514890 |
Total Medical Medicare Allowed Amount |
23997 |
Total Medical Medicare Payment Amount |
18568.06 |
Total Medical Medicare Standardized Payment Amount |
20401.73 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
60 |
Number Of Beneficiaries Age 75 to 84 |
26 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
55 |
Number Of Male Beneficiaries |
52 |
Number Of Non Hispanic White Beneficiaries |
95 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
85 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8192 |