National Provider Identifier [NPI]: |
1891795852 |
Last Name Of The Provider |
DABAGIA |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2512 E DUPONT RD |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
FORT WAYNE |
Zip Code Of The Provider |
468251609 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
90 |
Number Of Services |
11996.1 |
Number Of Medicare Beneficiaries |
596 |
Total Submitted Charge Amount |
787686.16 |
Total Medicare Allowed Amount |
255804.24 |
Total Medicare Payment Amount |
192313.55 |
Total Medicare Standardized Payment Amount |
203460.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
9808 |
Number Of Medicare Beneficiaries With Drug Services |
68 |
Total Drug Submitted ChargeAmount |
103155.6 |
Total Drug Medicare AllowedAmount |
26393.14 |
Total Drug Medicare PaymentAmount |
20432.72 |
Total Drug Medicare Standardized Payment Amount |
20432.72 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
83 |
Number Of Medical Services |
2188.1 |
Number Of Medicare Beneficiaries With Medical Services |
596 |
Total Medical Submitted Charge Amount |
684530.56 |
Total Medical Medicare Allowed Amount |
229411.1 |
Total Medical Medicare Payment Amount |
171880.83 |
Total Medical Medicare Standardized Payment Amount |
183027.8 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
80 |
Number Of Beneficiaries Age 65 to 74 |
295 |
Number Of Beneficiaries Age 75 to 84 |
159 |
Number Of Beneficiaries Age Greater 84 |
62 |
Number Of Female Beneficiaries |
142 |
Number Of Male Beneficiaries |
454 |
Number Of Non Hispanic White Beneficiaries |
543 |
Number Of Black or African American Beneficiaries |
19 |
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 |
18 |
Number Of Beneficiaries With Medicare Only Entitlement |
509 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
87 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
30 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
45 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.6305 |