National Provider Identifier [NPI]: |
1629173992 |
Last Name Of The Provider |
EDLUND |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
MD MOH |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1241 SOUTH TAMIAMI TRAIL |
Street Address 2 Of The Provider |
|
City Of The Provider |
SARASOTA |
Zip Code Of The Provider |
34239 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
4674 |
Number Of Medicare Beneficiaries |
326 |
Total Submitted Charge Amount |
549045 |
Total Medicare Allowed Amount |
412165.75 |
Total Medicare Payment Amount |
311669.45 |
Total Medicare Standardized Payment Amount |
317946.08 |
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 |
15 |
Number Of Medical Services |
4674 |
Number Of Medicare Beneficiaries With Medical Services |
326 |
Total Medical Submitted Charge Amount |
549045 |
Total Medical Medicare Allowed Amount |
412165.75 |
Total Medical Medicare Payment Amount |
311669.45 |
Total Medical Medicare Standardized Payment Amount |
317946.08 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
46 |
Number Of Beneficiaries Age 65 to 74 |
165 |
Number Of Beneficiaries Age 75 to 84 |
87 |
Number Of Beneficiaries Age Greater 84 |
28 |
Number Of Female Beneficiaries |
208 |
Number Of Male Beneficiaries |
118 |
Number Of Non Hispanic White Beneficiaries |
314 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
303 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
53 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.2401 |