National Provider Identifier [NPI]: |
1013987288 |
Last Name Of The Provider |
NUSSBAUM |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9716 RIVERSIDE PARKWAY |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
TULSA |
Zip Code Of The Provider |
74137 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
88 |
Number Of Services |
1750 |
Number Of Medicare Beneficiaries |
406 |
Total Submitted Charge Amount |
103683.55 |
Total Medicare Allowed Amount |
50572.55 |
Total Medicare Payment Amount |
33242.5 |
Total Medicare Standardized Payment Amount |
37635.09 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
18 |
Number Of Drug Services |
794 |
Number Of Medicare Beneficiaries With Drug Services |
123 |
Total Drug Submitted ChargeAmount |
10879 |
Total Drug Medicare AllowedAmount |
715.62 |
Total Drug Medicare PaymentAmount |
470.08 |
Total Drug Medicare Standardized Payment Amount |
470.08 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
70 |
Number Of Medical Services |
956 |
Number Of Medicare Beneficiaries With Medical Services |
405 |
Total Medical Submitted Charge Amount |
92804.55 |
Total Medical Medicare Allowed Amount |
49856.93 |
Total Medical Medicare Payment Amount |
32772.42 |
Total Medical Medicare Standardized Payment Amount |
37165.01 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
63 |
Number Of Beneficiaries Age 65 to 74 |
206 |
Number Of Beneficiaries Age 75 to 84 |
97 |
Number Of Beneficiaries Age Greater 84 |
40 |
Number Of Female Beneficiaries |
258 |
Number Of Male Beneficiaries |
148 |
Number Of Non Hispanic White Beneficiaries |
351 |
Number Of Black or African American Beneficiaries |
12 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
26 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
360 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
46 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.0026 |