National Provider Identifier [NPI]: |
1104895374 |
Last Name Of The Provider |
SHELDON |
First Name Of The Provider |
MARTIN |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1315 ROBERTS ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CAMDEN |
Zip Code Of The Provider |
290203737 |
State Code Of The Provider |
SC |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
1701 |
Number Of Medicare Beneficiaries |
400 |
Total Submitted Charge Amount |
373656.11 |
Total Medicare Allowed Amount |
166541.19 |
Total Medicare Payment Amount |
129022.26 |
Total Medicare Standardized Payment Amount |
134183.39 |
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 |
22 |
Number Of Medical Services |
1701 |
Number Of Medicare Beneficiaries With Medical Services |
400 |
Total Medical Submitted Charge Amount |
373656.11 |
Total Medical Medicare Allowed Amount |
166541.19 |
Total Medical Medicare Payment Amount |
129022.26 |
Total Medical Medicare Standardized Payment Amount |
134183.39 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
89 |
Number Of Beneficiaries Age 65 to 74 |
125 |
Number Of Beneficiaries Age 75 to 84 |
114 |
Number Of Beneficiaries Age Greater 84 |
72 |
Number Of Female Beneficiaries |
227 |
Number Of Male Beneficiaries |
173 |
Number Of Non Hispanic White Beneficiaries |
249 |
Number Of Black or African American Beneficiaries |
138 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
266 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
134 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
19 |
Percent Of With Heart Failure |
55 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
46 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
53 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.766 |