National Provider Identifier [NPI]: |
1841396660 |
Last Name Of The Provider |
ATTLESEY |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3625 UNIVERSITY BLVD S |
Street Address 2 Of The Provider |
|
City Of The Provider |
JACKSONVILLE |
Zip Code Of The Provider |
322164207 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
1009 |
Number Of Medicare Beneficiaries |
859 |
Total Submitted Charge Amount |
1330885 |
Total Medicare Allowed Amount |
160065.14 |
Total Medicare Payment Amount |
123483.15 |
Total Medicare Standardized Payment Amount |
121347.58 |
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 |
19 |
Number Of Medical Services |
1009 |
Number Of Medicare Beneficiaries With Medical Services |
859 |
Total Medical Submitted Charge Amount |
1330885 |
Total Medical Medicare Allowed Amount |
160065.14 |
Total Medical Medicare Payment Amount |
123483.15 |
Total Medical Medicare Standardized Payment Amount |
121347.58 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
247 |
Number Of Beneficiaries Age 65 to 74 |
241 |
Number Of Beneficiaries Age 75 to 84 |
213 |
Number Of Beneficiaries Age Greater 84 |
158 |
Number Of Female Beneficiaries |
507 |
Number Of Male Beneficiaries |
352 |
Number Of Non Hispanic White Beneficiaries |
590 |
Number Of Black or African American Beneficiaries |
211 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
36 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
491 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
368 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
28 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
45 |
Percent Of With Chronic Kidney Disease |
54 |
Percent Of With Chronic Obstructive Pulmonary Disease |
39 |
Percent Of With Depression |
42 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
63 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
17 |
Average HCC Risk Score Of Beneficiaries |
2.5813 |