National Provider Identifier [NPI]: |
1124063177 |
Last Name Of The Provider |
HILL |
First Name Of The Provider |
ROBERT |
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 |
3167 ELMENDORF CIR |
Street Address 2 Of The Provider |
CITY OF CHATTANOOGA WELLADVANTAGE WELLNESS CENTER |
City Of The Provider |
CHATTANOOGA |
Zip Code Of The Provider |
374064004 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
419 |
Number Of Medicare Beneficiaries |
343 |
Total Submitted Charge Amount |
424436.6 |
Total Medicare Allowed Amount |
48125.54 |
Total Medicare Payment Amount |
37212.15 |
Total Medicare Standardized Payment Amount |
38917.47 |
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 |
419 |
Number Of Medicare Beneficiaries With Medical Services |
343 |
Total Medical Submitted Charge Amount |
424436.6 |
Total Medical Medicare Allowed Amount |
48125.54 |
Total Medical Medicare Payment Amount |
37212.15 |
Total Medical Medicare Standardized Payment Amount |
38917.47 |
Average Age Of Beneficiaries |
65 |
Number Of Beneficiaries Age Less65 |
144 |
Number Of Beneficiaries Age 65 to 74 |
101 |
Number Of Beneficiaries Age 75 to 84 |
70 |
Number Of Beneficiaries Age Greater 84 |
28 |
Number Of Female Beneficiaries |
211 |
Number Of Male Beneficiaries |
132 |
Number Of Non Hispanic White Beneficiaries |
314 |
Number Of Black or African American Beneficiaries |
17 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
0 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
155 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
188 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
33 |
Percent Of With Chronic Obstructive Pulmonary Disease |
36 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.6188 |