National Provider Identifier [NPI]: |
1578727368 |
Last Name Of The Provider |
JONES |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
OD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
118 W WASHINGTON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
EFFINGHAM |
Zip Code Of The Provider |
624012354 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Optometry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
1166 |
Number Of Medicare Beneficiaries |
181 |
Total Submitted Charge Amount |
53890.47 |
Total Medicare Allowed Amount |
50430.81 |
Total Medicare Payment Amount |
34030.16 |
Total Medicare Standardized Payment Amount |
36662.09 |
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 |
28 |
Number Of Medical Services |
1166 |
Number Of Medicare Beneficiaries With Medical Services |
181 |
Total Medical Submitted Charge Amount |
53890.47 |
Total Medical Medicare Allowed Amount |
50430.81 |
Total Medical Medicare Payment Amount |
34030.16 |
Total Medical Medicare Standardized Payment Amount |
36662.09 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
12 |
Number Of Beneficiaries Age 65 to 74 |
98 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
19 |
Number Of Female Beneficiaries |
98 |
Number Of Male Beneficiaries |
83 |
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 |
169 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
|
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8406 |