National Provider Identifier [NPI]: |
1285733345 |
Last Name Of The Provider |
LEE |
First Name Of The Provider |
SHAWN |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
13313 N MERIDIAN AVE |
Street Address 2 Of The Provider |
BUILDING D |
City Of The Provider |
OKLAHOMA CITY |
Zip Code Of The Provider |
731208380 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pulmonary Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
30 |
Number Of Services |
1068 |
Number Of Medicare Beneficiaries |
391 |
Total Submitted Charge Amount |
169551 |
Total Medicare Allowed Amount |
92797.34 |
Total Medicare Payment Amount |
70483.3 |
Total Medicare Standardized Payment Amount |
75341.18 |
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 |
30 |
Number Of Medical Services |
1068 |
Number Of Medicare Beneficiaries With Medical Services |
391 |
Total Medical Submitted Charge Amount |
169551 |
Total Medical Medicare Allowed Amount |
92797.34 |
Total Medical Medicare Payment Amount |
70483.3 |
Total Medical Medicare Standardized Payment Amount |
75341.18 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
73 |
Number Of Beneficiaries Age 65 to 74 |
138 |
Number Of Beneficiaries Age 75 to 84 |
126 |
Number Of Beneficiaries Age Greater 84 |
54 |
Number Of Female Beneficiaries |
223 |
Number Of Male Beneficiaries |
168 |
Number Of Non Hispanic White Beneficiaries |
341 |
Number Of Black or African American Beneficiaries |
28 |
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 |
308 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
83 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
21 |
Percent Of With Asthma |
23 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
47 |
Percent Of With Chronic Kidney Disease |
51 |
Percent Of With Chronic Obstructive Pulmonary Disease |
52 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
54 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
17 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
1.9148 |