National Provider Identifier [NPI]: |
1003852013 |
Last Name Of The Provider |
WALKENSTEIN |
First Name Of The Provider |
NOI |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
DO |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5458 RIDGE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
PHILADELPHIA |
Zip Code Of The Provider |
191283732 |
State Code Of The Provider |
PA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
252 |
Number Of Medicare Beneficiaries |
178 |
Total Submitted Charge Amount |
61481.1 |
Total Medicare Allowed Amount |
28222.81 |
Total Medicare Payment Amount |
21955.21 |
Total Medicare Standardized Payment Amount |
20649.18 |
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 |
252 |
Number Of Medicare Beneficiaries With Medical Services |
178 |
Total Medical Submitted Charge Amount |
61481.1 |
Total Medical Medicare Allowed Amount |
28222.81 |
Total Medical Medicare Payment Amount |
21955.21 |
Total Medical Medicare Standardized Payment Amount |
20649.18 |
Average Age Of Beneficiaries |
49 |
Number Of Beneficiaries Age Less65 |
141 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
16 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
75 |
Number Of Male Beneficiaries |
103 |
Number Of Non Hispanic White Beneficiaries |
86 |
Number Of Black or African American Beneficiaries |
71 |
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 |
27 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
151 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
24 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
28 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
64 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.445 |