National Provider Identifier [NPI]: |
1144223470 |
Last Name Of The Provider |
VITHESPONGSE |
First Name Of The Provider |
PRIDIPONGSE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
103 W 2ND ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
HEDRICK |
Zip Code Of The Provider |
525637769 |
State Code Of The Provider |
IA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
26 |
Number Of Services |
808 |
Number Of Medicare Beneficiaries |
106 |
Total Submitted Charge Amount |
66391 |
Total Medicare Allowed Amount |
58393.02 |
Total Medicare Payment Amount |
42929.96 |
Total Medicare Standardized Payment Amount |
45947.97 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
85 |
Number Of Medicare Beneficiaries With Drug Services |
44 |
Total Drug Submitted ChargeAmount |
1798 |
Total Drug Medicare AllowedAmount |
759.71 |
Total Drug Medicare PaymentAmount |
686.65 |
Total Drug Medicare Standardized Payment Amount |
686.65 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
723 |
Number Of Medicare Beneficiaries With Medical Services |
106 |
Total Medical Submitted Charge Amount |
64593 |
Total Medical Medicare Allowed Amount |
57633.31 |
Total Medical Medicare Payment Amount |
42243.31 |
Total Medical Medicare Standardized Payment Amount |
45261.32 |
Average Age Of Beneficiaries |
79 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
57 |
Number Of Male Beneficiaries |
49 |
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 |
74 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
32 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
45 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
48 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
36 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
72 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.4486 |