National Provider Identifier [NPI]: |
1285608570 |
Last Name Of The Provider |
THOMAS |
First Name Of The Provider |
KRIS |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 1ST ST SW |
Street Address 2 Of The Provider |
|
City Of The Provider |
ROCHESTER |
Zip Code Of The Provider |
559050001 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
241 |
Number Of Medicare Beneficiaries |
145 |
Total Submitted Charge Amount |
20778.99 |
Total Medicare Allowed Amount |
17731.86 |
Total Medicare Payment Amount |
10753.95 |
Total Medicare Standardized Payment Amount |
11975.84 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
13 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
330.95 |
Total Drug Medicare AllowedAmount |
330.03 |
Total Drug Medicare PaymentAmount |
319.95 |
Total Drug Medicare Standardized Payment Amount |
319.95 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
9 |
Number Of Medical Services |
228 |
Number Of Medicare Beneficiaries With Medical Services |
145 |
Total Medical Submitted Charge Amount |
20448.04 |
Total Medical Medicare Allowed Amount |
17401.83 |
Total Medical Medicare Payment Amount |
10434 |
Total Medical Medicare Standardized Payment Amount |
11655.89 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
49 |
Number Of Beneficiaries Age Greater 84 |
28 |
Number Of Female Beneficiaries |
107 |
Number Of Male Beneficiaries |
38 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
121 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
24 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
19 |
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
34 |
Percent Of With Hypertension |
56 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.96 |