National Provider Identifier [NPI]: |
1063487940 |
Last Name Of The Provider |
GIDES |
First Name Of The Provider |
JAMES |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
320 MAIN ST |
Street Address 2 Of The Provider |
2ND FLOOR |
City Of The Provider |
JOHNSTOWN |
Zip Code Of The Provider |
159011601 |
State Code Of The Provider |
PA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
437 |
Number Of Medicare Beneficiaries |
226 |
Total Submitted Charge Amount |
67371 |
Total Medicare Allowed Amount |
43543.71 |
Total Medicare Payment Amount |
33734.61 |
Total Medicare Standardized Payment Amount |
40486.35 |
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 |
437 |
Number Of Medicare Beneficiaries With Medical Services |
226 |
Total Medical Submitted Charge Amount |
67371 |
Total Medical Medicare Allowed Amount |
43543.71 |
Total Medical Medicare Payment Amount |
33734.61 |
Total Medical Medicare Standardized Payment Amount |
40486.35 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
94 |
Number Of Beneficiaries Age 65 to 74 |
44 |
Number Of Beneficiaries Age 75 to 84 |
48 |
Number Of Beneficiaries Age Greater 84 |
40 |
Number Of Female Beneficiaries |
116 |
Number Of Male Beneficiaries |
110 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
112 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
114 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
54 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
40 |
Percent Of With Chronic Kidney Disease |
55 |
Percent Of With Chronic Obstructive Pulmonary Disease |
33 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
56 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
44 |
Percent Of With Stroke |
14 |
Average HCC Risk Score Of Beneficiaries |
2.1462 |