National Provider Identifier [NPI]: |
1639164080 |
Last Name Of The Provider |
SELLERS |
First Name Of The Provider |
MONTE |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
520 S 7TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
VINCENNES |
Zip Code Of The Provider |
475911038 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
815 |
Number Of Medicare Beneficiaries |
724 |
Total Submitted Charge Amount |
526156.5 |
Total Medicare Allowed Amount |
103154.39 |
Total Medicare Payment Amount |
74281.1 |
Total Medicare Standardized Payment Amount |
77470.68 |
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 |
25 |
Number Of Medical Services |
815 |
Number Of Medicare Beneficiaries With Medical Services |
724 |
Total Medical Submitted Charge Amount |
526156.5 |
Total Medical Medicare Allowed Amount |
103154.39 |
Total Medical Medicare Payment Amount |
74281.1 |
Total Medical Medicare Standardized Payment Amount |
77470.68 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
164 |
Number Of Beneficiaries Age 65 to 74 |
195 |
Number Of Beneficiaries Age 75 to 84 |
212 |
Number Of Beneficiaries Age Greater 84 |
153 |
Number Of Female Beneficiaries |
432 |
Number Of Male Beneficiaries |
292 |
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 |
491 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
233 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
31 |
Percent Of With Chronic Kidney Disease |
32 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
52 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.5678 |