National Provider Identifier [NPI]: |
1225358740 |
Last Name Of The Provider |
HAGEN |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1930 CROWN PARK CT |
Street Address 2 Of The Provider |
|
City Of The Provider |
COLUMBUS |
Zip Code Of The Provider |
432352402 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
101 |
Number Of Services |
1533 |
Number Of Medicare Beneficiaries |
116 |
Total Submitted Charge Amount |
79760 |
Total Medicare Allowed Amount |
47521.23 |
Total Medicare Payment Amount |
37024.53 |
Total Medicare Standardized Payment Amount |
38258.56 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
201 |
Number Of Medicare Beneficiaries With Drug Services |
45 |
Total Drug Submitted ChargeAmount |
4124 |
Total Drug Medicare AllowedAmount |
3007.55 |
Total Drug Medicare PaymentAmount |
2865.68 |
Total Drug Medicare Standardized Payment Amount |
2865.68 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
92 |
Number Of Medical Services |
1332 |
Number Of Medicare Beneficiaries With Medical Services |
116 |
Total Medical Submitted Charge Amount |
75636 |
Total Medical Medicare Allowed Amount |
44513.68 |
Total Medical Medicare Payment Amount |
34158.85 |
Total Medical Medicare Standardized Payment Amount |
35392.88 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
54 |
Number Of Beneficiaries Age 75 to 84 |
30 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
62 |
Number Of Male Beneficiaries |
54 |
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 |
103 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
13 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
20 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8792 |