National Provider Identifier [NPI]: |
1598741480 |
Last Name Of The Provider |
UNRUH |
First Name Of The Provider |
TERRY |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4222 WENDOVER AVE |
Street Address 2 Of The Provider |
SUITE 800 |
City Of The Provider |
ODESSA |
Zip Code Of The Provider |
797625945 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
66 |
Number Of Services |
432 |
Number Of Medicare Beneficiaries |
181 |
Total Submitted Charge Amount |
255160 |
Total Medicare Allowed Amount |
83174.48 |
Total Medicare Payment Amount |
61970.92 |
Total Medicare Standardized Payment Amount |
65921.91 |
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 |
66 |
Number Of Medical Services |
432 |
Number Of Medicare Beneficiaries With Medical Services |
181 |
Total Medical Submitted Charge Amount |
255160 |
Total Medical Medicare Allowed Amount |
83174.48 |
Total Medical Medicare Payment Amount |
61970.92 |
Total Medical Medicare Standardized Payment Amount |
65921.91 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
22 |
Number Of Beneficiaries Age 65 to 74 |
92 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
122 |
Number Of Male Beneficiaries |
59 |
Number Of Non Hispanic White Beneficiaries |
133 |
Number Of Black or African American Beneficiaries |
|
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 |
152 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
29 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
|
Percent Of With Cancer |
32 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
38 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
38 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0316 |