National Provider Identifier [NPI]: |
1669458451 |
Last Name Of The Provider |
MCDANIEL |
First Name Of The Provider |
TANNER |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1201 S DOUGLAS BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
MIDWEST CITY |
Zip Code Of The Provider |
731305239 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
75 |
Number Of Services |
4794 |
Number Of Medicare Beneficiaries |
291 |
Total Submitted Charge Amount |
217639.1 |
Total Medicare Allowed Amount |
118699.81 |
Total Medicare Payment Amount |
87674.75 |
Total Medicare Standardized Payment Amount |
93902.51 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
145 |
Number Of Medicare Beneficiaries With Drug Services |
98 |
Total Drug Submitted ChargeAmount |
6025.1 |
Total Drug Medicare AllowedAmount |
2568.03 |
Total Drug Medicare PaymentAmount |
2373.24 |
Total Drug Medicare Standardized Payment Amount |
2373.24 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
66 |
Number Of Medical Services |
4649 |
Number Of Medicare Beneficiaries With Medical Services |
291 |
Total Medical Submitted Charge Amount |
211614 |
Total Medical Medicare Allowed Amount |
116131.78 |
Total Medical Medicare Payment Amount |
85301.51 |
Total Medical Medicare Standardized Payment Amount |
91529.27 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
142 |
Number Of Beneficiaries Age 75 to 84 |
96 |
Number Of Beneficiaries Age Greater 84 |
37 |
Number Of Female Beneficiaries |
162 |
Number Of Male Beneficiaries |
129 |
Number Of Non Hispanic White Beneficiaries |
267 |
Number Of Black or African American Beneficiaries |
13 |
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 |
277 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
73 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0422 |