National Provider Identifier [NPI]: |
1457336539 |
Last Name Of The Provider |
WANG |
First Name Of The Provider |
JUN |
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 |
10351 DAWSONS CREEK BLVD |
Street Address 2 Of The Provider |
STE D |
City Of The Provider |
FORT WAYNE |
Zip Code Of The Provider |
468251904 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
63 |
Number Of Services |
316 |
Number Of Medicare Beneficiaries |
271 |
Total Submitted Charge Amount |
169517 |
Total Medicare Allowed Amount |
36567.48 |
Total Medicare Payment Amount |
27988.87 |
Total Medicare Standardized Payment Amount |
28565.98 |
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 |
63 |
Number Of Medical Services |
316 |
Number Of Medicare Beneficiaries With Medical Services |
271 |
Total Medical Submitted Charge Amount |
169517 |
Total Medical Medicare Allowed Amount |
36567.48 |
Total Medical Medicare Payment Amount |
27988.87 |
Total Medical Medicare Standardized Payment Amount |
28565.98 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
72 |
Number Of Beneficiaries Age 65 to 74 |
113 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
35 |
Number Of Female Beneficiaries |
147 |
Number Of Male Beneficiaries |
124 |
Number Of Non Hispanic White Beneficiaries |
248 |
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 |
189 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
82 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
21 |
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
65 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.6368 |