National Provider Identifier [NPI]: |
1013117498 |
Last Name Of The Provider |
SAMARITONI |
First Name Of The Provider |
ADAM |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6500 HOSPITAL DR |
Street Address 2 Of The Provider |
FAMILY MEDICINE |
City Of The Provider |
HANNIBAL |
Zip Code Of The Provider |
634016890 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
536 |
Number Of Medicare Beneficiaries |
166 |
Total Submitted Charge Amount |
54628 |
Total Medicare Allowed Amount |
37544.85 |
Total Medicare Payment Amount |
26070.71 |
Total Medicare Standardized Payment Amount |
28870.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
33 |
Number Of Medicare Beneficiaries With Drug Services |
31 |
Total Drug Submitted ChargeAmount |
850 |
Total Drug Medicare AllowedAmount |
751.02 |
Total Drug Medicare PaymentAmount |
736.02 |
Total Drug Medicare Standardized Payment Amount |
736.02 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
503 |
Number Of Medicare Beneficiaries With Medical Services |
166 |
Total Medical Submitted Charge Amount |
53778 |
Total Medical Medicare Allowed Amount |
36793.83 |
Total Medical Medicare Payment Amount |
25334.69 |
Total Medical Medicare Standardized Payment Amount |
28134.28 |
Average Age Of Beneficiaries |
62 |
Number Of Beneficiaries Age Less65 |
81 |
Number Of Beneficiaries Age 65 to 74 |
56 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
97 |
Number Of Male Beneficiaries |
69 |
Number Of Non Hispanic White Beneficiaries |
154 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
83 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
83 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1356 |