National Provider Identifier [NPI]: |
1659314615 |
Last Name Of The Provider |
WHITE |
First Name Of The Provider |
TONY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 MEDICAL CENTER DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
FORT PAYNE |
Zip Code Of The Provider |
35968 |
State Code Of The Provider |
AL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
19 |
Number Of Services |
706 |
Number Of Medicare Beneficiaries |
620 |
Total Submitted Charge Amount |
1019897 |
Total Medicare Allowed Amount |
107369.58 |
Total Medicare Payment Amount |
81881.95 |
Total Medicare Standardized Payment Amount |
87054.58 |
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 |
19 |
Number Of Medical Services |
706 |
Number Of Medicare Beneficiaries With Medical Services |
620 |
Total Medical Submitted Charge Amount |
1019897 |
Total Medical Medicare Allowed Amount |
107369.58 |
Total Medical Medicare Payment Amount |
81881.95 |
Total Medical Medicare Standardized Payment Amount |
87054.58 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
178 |
Number Of Beneficiaries Age 65 to 74 |
176 |
Number Of Beneficiaries Age 75 to 84 |
163 |
Number Of Beneficiaries Age Greater 84 |
103 |
Number Of Female Beneficiaries |
384 |
Number Of Male Beneficiaries |
236 |
Number Of Non Hispanic White Beneficiaries |
603 |
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 |
364 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
256 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
21 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.5098 |