National Provider Identifier [NPI]: |
1447244181 |
Last Name Of The Provider |
EHRLICH |
First Name Of The Provider |
THOMAS |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3650 JOSEPH SIEWICK DR |
Street Address 2 Of The Provider |
SUITE 400 |
City Of The Provider |
FAIRFAX |
Zip Code Of The Provider |
220331710 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
61 |
Number Of Services |
1487 |
Number Of Medicare Beneficiaries |
338 |
Total Submitted Charge Amount |
172364 |
Total Medicare Allowed Amount |
86772.14 |
Total Medicare Payment Amount |
61334.5 |
Total Medicare Standardized Payment Amount |
55011.31 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
112 |
Number Of Medicare Beneficiaries With Drug Services |
75 |
Total Drug Submitted ChargeAmount |
4602 |
Total Drug Medicare AllowedAmount |
2515.73 |
Total Drug Medicare PaymentAmount |
2377.47 |
Total Drug Medicare Standardized Payment Amount |
2377.47 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
54 |
Number Of Medical Services |
1375 |
Number Of Medicare Beneficiaries With Medical Services |
338 |
Total Medical Submitted Charge Amount |
167762 |
Total Medical Medicare Allowed Amount |
84256.41 |
Total Medical Medicare Payment Amount |
58957.03 |
Total Medical Medicare Standardized Payment Amount |
52633.84 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
25 |
Number Of Beneficiaries Age 65 to 74 |
200 |
Number Of Beneficiaries Age 75 to 84 |
80 |
Number Of Beneficiaries Age Greater 84 |
33 |
Number Of Female Beneficiaries |
163 |
Number Of Male Beneficiaries |
175 |
Number Of Non Hispanic White Beneficiaries |
299 |
Number Of Black or African American Beneficiaries |
14 |
Number Of AsianPacific Islander Beneficiaries |
12 |
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 |
321 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
17 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
48 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.8661 |