National Provider Identifier [NPI]: |
1073743472 |
Last Name Of The Provider |
ROYCE |
First Name Of The Provider |
BRYAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
421 CAMELOT DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
FOND DU LAC |
Zip Code Of The Provider |
549358335 |
State Code Of The Provider |
WI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
45 |
Number Of Services |
153 |
Number Of Medicare Beneficiaries |
55 |
Total Submitted Charge Amount |
118489.5 |
Total Medicare Allowed Amount |
19743.17 |
Total Medicare Payment Amount |
15350.62 |
Total Medicare Standardized Payment Amount |
16054.02 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
13 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
202 |
Total Drug Medicare AllowedAmount |
47.94 |
Total Drug Medicare PaymentAmount |
37.6 |
Total Drug Medicare Standardized Payment Amount |
37.6 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
140 |
Number Of Medicare Beneficiaries With Medical Services |
55 |
Total Medical Submitted Charge Amount |
118287.5 |
Total Medical Medicare Allowed Amount |
19695.23 |
Total Medical Medicare Payment Amount |
15313.02 |
Total Medical Medicare Standardized Payment Amount |
16016.42 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
22 |
Number Of Beneficiaries Age 75 to 84 |
16 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
37 |
Number Of Male Beneficiaries |
18 |
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 |
44 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
24 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
53 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8529 |