National Provider Identifier [NPI]: |
1720046881 |
Last Name Of The Provider |
CRAIG |
First Name Of The Provider |
KEVIN |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3217 S PROVIDENCE RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
COLUMBIA |
Zip Code Of The Provider |
652033639 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Geriatric Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
20 |
Number Of Services |
867 |
Number Of Medicare Beneficiaries |
318 |
Total Submitted Charge Amount |
142580 |
Total Medicare Allowed Amount |
62651.53 |
Total Medicare Payment Amount |
46394.66 |
Total Medicare Standardized Payment Amount |
49039.63 |
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 |
20 |
Number Of Medical Services |
867 |
Number Of Medicare Beneficiaries With Medical Services |
318 |
Total Medical Submitted Charge Amount |
142580 |
Total Medical Medicare Allowed Amount |
62651.53 |
Total Medical Medicare Payment Amount |
46394.66 |
Total Medical Medicare Standardized Payment Amount |
49039.63 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
36 |
Number Of Beneficiaries Age 65 to 74 |
88 |
Number Of Beneficiaries Age 75 to 84 |
89 |
Number Of Beneficiaries Age Greater 84 |
105 |
Number Of Female Beneficiaries |
182 |
Number Of Male Beneficiaries |
136 |
Number Of Non Hispanic White Beneficiaries |
291 |
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 |
225 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
93 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
31 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
43 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
48 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
2.1224 |