National Provider Identifier [NPI]: |
1154389864 |
Last Name Of The Provider |
DUNDORE |
First Name Of The Provider |
PAUL |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
800 PRUDENTIAL DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
JACKSONVILLE |
Zip Code Of The Provider |
32207 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pathology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
41 |
Number Of Services |
5145 |
Number Of Medicare Beneficiaries |
1831 |
Total Submitted Charge Amount |
774338.37 |
Total Medicare Allowed Amount |
187454.92 |
Total Medicare Payment Amount |
145572.41 |
Total Medicare Standardized Payment Amount |
125600.33 |
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 |
41 |
Number Of Medical Services |
5145 |
Number Of Medicare Beneficiaries With Medical Services |
1831 |
Total Medical Submitted Charge Amount |
774338.37 |
Total Medical Medicare Allowed Amount |
187454.92 |
Total Medical Medicare Payment Amount |
145572.41 |
Total Medical Medicare Standardized Payment Amount |
125600.33 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
215 |
Number Of Beneficiaries Age 65 to 74 |
868 |
Number Of Beneficiaries Age 75 to 84 |
527 |
Number Of Beneficiaries Age Greater 84 |
221 |
Number Of Female Beneficiaries |
996 |
Number Of Male Beneficiaries |
835 |
Number Of Non Hispanic White Beneficiaries |
1553 |
Number Of Black or African American Beneficiaries |
181 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
50 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
24 |
Number Of Beneficiaries With Medicare Only Entitlement |
1604 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
227 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
23 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.6264 |