National Provider Identifier [NPI]: |
1689745085 |
Last Name Of The Provider |
VO |
First Name Of The Provider |
KATIE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
510 S KINGSHIGHWAY BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAINT LOUIS |
Zip Code Of The Provider |
631101016 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
56 |
Number Of Services |
2914 |
Number Of Medicare Beneficiaries |
2027 |
Total Submitted Charge Amount |
898015 |
Total Medicare Allowed Amount |
184919.83 |
Total Medicare Payment Amount |
142897.22 |
Total Medicare Standardized Payment Amount |
147297.73 |
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 |
56 |
Number Of Medical Services |
2914 |
Number Of Medicare Beneficiaries With Medical Services |
2027 |
Total Medical Submitted Charge Amount |
898015 |
Total Medical Medicare Allowed Amount |
184919.83 |
Total Medical Medicare Payment Amount |
142897.22 |
Total Medical Medicare Standardized Payment Amount |
147297.73 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
613 |
Number Of Beneficiaries Age 65 to 74 |
754 |
Number Of Beneficiaries Age 75 to 84 |
462 |
Number Of Beneficiaries Age Greater 84 |
198 |
Number Of Female Beneficiaries |
1084 |
Number Of Male Beneficiaries |
943 |
Number Of Non Hispanic White Beneficiaries |
1472 |
Number Of Black or African American Beneficiaries |
487 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
17 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
36 |
Number Of Beneficiaries With Medicare Only Entitlement |
1412 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
615 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
18 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
19 |
Average HCC Risk Score Of Beneficiaries |
1.9891 |