National Provider Identifier [NPI]: |
1952596140 |
Last Name Of The Provider |
PHILLIPS |
First Name Of The Provider |
SHERMAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
|
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1968 PEACHTREE RD NW |
Street Address 2 Of The Provider |
|
City Of The Provider |
ATLANTA |
Zip Code Of The Provider |
303091281 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiologist Assistants |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
30 |
Number Of Services |
163 |
Number Of Medicare Beneficiaries |
157 |
Total Submitted Charge Amount |
144730 |
Total Medicare Allowed Amount |
25026.81 |
Total Medicare Payment Amount |
19512.39 |
Total Medicare Standardized Payment Amount |
19552.4 |
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 |
30 |
Number Of Medical Services |
163 |
Number Of Medicare Beneficiaries With Medical Services |
157 |
Total Medical Submitted Charge Amount |
144730 |
Total Medical Medicare Allowed Amount |
25026.81 |
Total Medical Medicare Payment Amount |
19512.39 |
Total Medical Medicare Standardized Payment Amount |
19552.4 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
56 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
65 |
Number Of Male Beneficiaries |
92 |
Number Of Non Hispanic White Beneficiaries |
119 |
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 |
131 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
26 |
Percent Of With Atrial Fibrillation |
41 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
47 |
Percent Of With Chronic Kidney Disease |
41 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
42 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
62 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
2.0718 |