National Provider Identifier [NPI]: |
1841629441 |
Last Name Of The Provider |
MATTHIESEN |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
|
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
50820 SUMMIT HILL CT |
Street Address 2 Of The Provider |
SHADOWFAX ANESTHESIA |
City Of The Provider |
GRANGER |
Zip Code Of The Provider |
465309720 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
CRNA |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
54 |
Number Of Services |
191 |
Number Of Medicare Beneficiaries |
167 |
Total Submitted Charge Amount |
216291.5 |
Total Medicare Allowed Amount |
47130.17 |
Total Medicare Payment Amount |
36910.37 |
Total Medicare Standardized Payment Amount |
38605.36 |
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 |
54 |
Number Of Medical Services |
191 |
Number Of Medicare Beneficiaries With Medical Services |
167 |
Total Medical Submitted Charge Amount |
216291.5 |
Total Medical Medicare Allowed Amount |
47130.17 |
Total Medical Medicare Payment Amount |
36910.37 |
Total Medical Medicare Standardized Payment Amount |
38605.36 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
54 |
Number Of Beneficiaries Age 75 to 84 |
49 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
106 |
Number Of Male Beneficiaries |
61 |
Number Of Non Hispanic White Beneficiaries |
155 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
127 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
40 |
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
17 |
Percent Of With Heart Failure |
31 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4803 |