National Provider Identifier [NPI]: |
1811942543 |
Last Name Of The Provider |
WRITER |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6140 W CURTISIAN |
Street Address 2 Of The Provider |
STE 200 |
City Of The Provider |
BOISE |
Zip Code Of The Provider |
83704 |
State Code Of The Provider |
ID |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
62 |
Number Of Services |
1959 |
Number Of Medicare Beneficiaries |
845 |
Total Submitted Charge Amount |
362381 |
Total Medicare Allowed Amount |
158383.69 |
Total Medicare Payment Amount |
117141.12 |
Total Medicare Standardized Payment Amount |
125758.2 |
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 |
62 |
Number Of Medical Services |
1959 |
Number Of Medicare Beneficiaries With Medical Services |
845 |
Total Medical Submitted Charge Amount |
362381 |
Total Medical Medicare Allowed Amount |
158383.69 |
Total Medical Medicare Payment Amount |
117141.12 |
Total Medical Medicare Standardized Payment Amount |
125758.2 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
74 |
Number Of Beneficiaries Age 65 to 74 |
344 |
Number Of Beneficiaries Age 75 to 84 |
308 |
Number Of Beneficiaries Age Greater 84 |
119 |
Number Of Female Beneficiaries |
360 |
Number Of Male Beneficiaries |
485 |
Number Of Non Hispanic White Beneficiaries |
811 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
18 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
748 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
97 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
65 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.2669 |