National Provider Identifier [NPI]: |
1720016462 |
Last Name Of The Provider |
KIELB |
First Name Of The Provider |
STEPHANIE |
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 |
680 N LAKE SHORE DR |
Street Address 2 Of The Provider |
SUITE 1000 |
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606114546 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
109 |
Number Of Services |
11708 |
Number Of Medicare Beneficiaries |
688 |
Total Submitted Charge Amount |
2042534 |
Total Medicare Allowed Amount |
408855.97 |
Total Medicare Payment Amount |
311609.99 |
Total Medicare Standardized Payment Amount |
292033.77 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
8308 |
Number Of Medicare Beneficiaries With Drug Services |
44 |
Total Drug Submitted ChargeAmount |
118955 |
Total Drug Medicare AllowedAmount |
45670.76 |
Total Drug Medicare PaymentAmount |
34774.55 |
Total Drug Medicare Standardized Payment Amount |
34774.55 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
106 |
Number Of Medical Services |
3400 |
Number Of Medicare Beneficiaries With Medical Services |
687 |
Total Medical Submitted Charge Amount |
1923579 |
Total Medical Medicare Allowed Amount |
363185.21 |
Total Medical Medicare Payment Amount |
276835.44 |
Total Medical Medicare Standardized Payment Amount |
257259.22 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
223 |
Number Of Beneficiaries Age 65 to 74 |
244 |
Number Of Beneficiaries Age 75 to 84 |
152 |
Number Of Beneficiaries Age Greater 84 |
69 |
Number Of Female Beneficiaries |
476 |
Number Of Male Beneficiaries |
212 |
Number Of Non Hispanic White Beneficiaries |
460 |
Number Of Black or African American Beneficiaries |
137 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
65 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
473 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
215 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.6972 |