National Provider Identifier [NPI]: |
1922209360 |
Last Name Of The Provider |
MONTGOMERY |
First Name Of The Provider |
VAN |
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 |
UT COLLEGE OF MEDICINE |
Street Address 2 Of The Provider |
920 MADISON AVE., SUITE C50 |
City Of The Provider |
MEMPHIS |
Zip Code Of The Provider |
381630001 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
184 |
Number Of Services |
2140 |
Number Of Medicare Beneficiaries |
1477 |
Total Submitted Charge Amount |
487014 |
Total Medicare Allowed Amount |
98234.84 |
Total Medicare Payment Amount |
75679.51 |
Total Medicare Standardized Payment Amount |
81053.5 |
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 |
184 |
Number Of Medical Services |
2140 |
Number Of Medicare Beneficiaries With Medical Services |
1477 |
Total Medical Submitted Charge Amount |
487014 |
Total Medical Medicare Allowed Amount |
98234.84 |
Total Medical Medicare Payment Amount |
75679.51 |
Total Medical Medicare Standardized Payment Amount |
81053.5 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
377 |
Number Of Beneficiaries Age 65 to 74 |
515 |
Number Of Beneficiaries Age 75 to 84 |
384 |
Number Of Beneficiaries Age Greater 84 |
201 |
Number Of Female Beneficiaries |
872 |
Number Of Male Beneficiaries |
605 |
Number Of Non Hispanic White Beneficiaries |
818 |
Number Of Black or African American Beneficiaries |
637 |
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 |
969 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
508 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
42 |
Percent Of With Chronic Kidney Disease |
52 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
53 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.4038 |