National Provider Identifier [NPI]: |
1518903715 |
Last Name Of The Provider |
SLAMA |
First Name Of The Provider |
WILLIAM |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1214 E NATIONAL AVE |
Street Address 2 Of The Provider |
SUITE 90A |
City Of The Provider |
BRAZIL |
Zip Code Of The Provider |
478342700 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
855 |
Number Of Medicare Beneficiaries |
280 |
Total Submitted Charge Amount |
133012 |
Total Medicare Allowed Amount |
68048.23 |
Total Medicare Payment Amount |
52105.93 |
Total Medicare Standardized Payment Amount |
53829.2 |
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 |
14 |
Number Of Medical Services |
855 |
Number Of Medicare Beneficiaries With Medical Services |
280 |
Total Medical Submitted Charge Amount |
133012 |
Total Medical Medicare Allowed Amount |
68048.23 |
Total Medical Medicare Payment Amount |
52105.93 |
Total Medical Medicare Standardized Payment Amount |
53829.2 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
64 |
Number Of Beneficiaries Age 65 to 74 |
73 |
Number Of Beneficiaries Age 75 to 84 |
85 |
Number Of Beneficiaries Age Greater 84 |
58 |
Number Of Female Beneficiaries |
161 |
Number Of Male Beneficiaries |
119 |
Number Of Non Hispanic White Beneficiaries |
253 |
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 |
186 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
94 |
Percent Of With Atrial Fibrillation |
25 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
20 |
Percent Of With Cancer |
20 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
51 |
Percent Of With Chronic Obstructive Pulmonary Disease |
46 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
53 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.8842 |