National Provider Identifier [NPI]: |
1689763252 |
Last Name Of The Provider |
STUTZ |
First Name Of The Provider |
STANLEY |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
112 MANSFIELD AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
WILLIMANTIC |
Zip Code Of The Provider |
062262045 |
State Code Of The Provider |
CT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
597 |
Number Of Medicare Beneficiaries |
417 |
Total Submitted Charge Amount |
302982 |
Total Medicare Allowed Amount |
77679.42 |
Total Medicare Payment Amount |
57922.84 |
Total Medicare Standardized Payment Amount |
54964.94 |
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 |
25 |
Number Of Medical Services |
597 |
Number Of Medicare Beneficiaries With Medical Services |
417 |
Total Medical Submitted Charge Amount |
302982 |
Total Medical Medicare Allowed Amount |
77679.42 |
Total Medical Medicare Payment Amount |
57922.84 |
Total Medical Medicare Standardized Payment Amount |
54964.94 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
126 |
Number Of Beneficiaries Age 65 to 74 |
95 |
Number Of Beneficiaries Age 75 to 84 |
102 |
Number Of Beneficiaries Age Greater 84 |
94 |
Number Of Female Beneficiaries |
251 |
Number Of Male Beneficiaries |
166 |
Number Of Non Hispanic White Beneficiaries |
338 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
57 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
194 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
223 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
26 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
40 |
Percent Of With Chronic Kidney Disease |
39 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
46 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.9551 |