National Provider Identifier [NPI]: |
1427016484 |
Last Name Of The Provider |
MERTENS |
First Name Of The Provider |
WILSON |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3350 MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPRINGFIELD |
Zip Code Of The Provider |
011991619 |
State Code Of The Provider |
MA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Hematology/Oncology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
505 |
Number Of Medicare Beneficiaries |
233 |
Total Submitted Charge Amount |
125595 |
Total Medicare Allowed Amount |
48909.2 |
Total Medicare Payment Amount |
36669.84 |
Total Medicare Standardized Payment Amount |
36879.77 |
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 |
11 |
Number Of Medical Services |
505 |
Number Of Medicare Beneficiaries With Medical Services |
233 |
Total Medical Submitted Charge Amount |
125595 |
Total Medical Medicare Allowed Amount |
48909.2 |
Total Medical Medicare Payment Amount |
36669.84 |
Total Medical Medicare Standardized Payment Amount |
36879.77 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
121 |
Number Of Beneficiaries Age 75 to 84 |
53 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
110 |
Number Of Male Beneficiaries |
123 |
Number Of Non Hispanic White Beneficiaries |
185 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
24 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
143 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
90 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
61 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
36 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.95 |