National Provider Identifier [NPI]: |
1356501068 |
Last Name Of The Provider |
DOHERTY |
First Name Of The Provider |
MATTHEW |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1250 E MARSHALL ST |
Street Address 2 Of The Provider |
RADIOLOGY |
City Of The Provider |
RICHMOND |
Zip Code Of The Provider |
232985051 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
60 |
Number Of Services |
1445 |
Number Of Medicare Beneficiaries |
846 |
Total Submitted Charge Amount |
113966 |
Total Medicare Allowed Amount |
27393.87 |
Total Medicare Payment Amount |
20357.91 |
Total Medicare Standardized Payment Amount |
21327.9 |
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 |
60 |
Number Of Medical Services |
1445 |
Number Of Medicare Beneficiaries With Medical Services |
846 |
Total Medical Submitted Charge Amount |
113966 |
Total Medical Medicare Allowed Amount |
27393.87 |
Total Medical Medicare Payment Amount |
20357.91 |
Total Medical Medicare Standardized Payment Amount |
21327.9 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
318 |
Number Of Beneficiaries Age 65 to 74 |
299 |
Number Of Beneficiaries Age 75 to 84 |
179 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
421 |
Number Of Male Beneficiaries |
425 |
Number Of Non Hispanic White Beneficiaries |
426 |
Number Of Black or African American Beneficiaries |
392 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
13 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
519 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
327 |
Percent Of With Atrial Fibrillation |
27 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
56 |
Percent Of With Chronic Kidney Disease |
61 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
61 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
15 |
Average HCC Risk Score Of Beneficiaries |
2.7043 |