National Provider Identifier [NPI]: |
1740254929 |
Last Name Of The Provider |
MCKEITHAN |
First Name Of The Provider |
ROISIN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1024 SOUTH BATTLEFIELD BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHESAPEAKE |
Zip Code Of The Provider |
233224215 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
771 |
Number Of Medicare Beneficiaries |
206 |
Total Submitted Charge Amount |
99859 |
Total Medicare Allowed Amount |
65998.69 |
Total Medicare Payment Amount |
46410.09 |
Total Medicare Standardized Payment Amount |
47857.94 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
78 |
Number Of Medicare Beneficiaries With Drug Services |
68 |
Total Drug Submitted ChargeAmount |
3975 |
Total Drug Medicare AllowedAmount |
2974.19 |
Total Drug Medicare PaymentAmount |
2902.89 |
Total Drug Medicare Standardized Payment Amount |
2902.89 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
693 |
Number Of Medicare Beneficiaries With Medical Services |
206 |
Total Medical Submitted Charge Amount |
95884 |
Total Medical Medicare Allowed Amount |
63024.5 |
Total Medical Medicare Payment Amount |
43507.2 |
Total Medical Medicare Standardized Payment Amount |
44955.05 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
100 |
Number Of Beneficiaries Age 75 to 84 |
65 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
166 |
Number Of Male Beneficiaries |
40 |
Number Of Non Hispanic White Beneficiaries |
190 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
18 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8785 |