National Provider Identifier [NPI]: |
1700871399 |
Last Name Of The Provider |
DUGUID |
First Name Of The Provider |
DALE |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3401 W GORE BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
LAWTON |
Zip Code Of The Provider |
73505 |
State Code Of The Provider |
OK |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
691 |
Number Of Medicare Beneficiaries |
405 |
Total Submitted Charge Amount |
178969.5 |
Total Medicare Allowed Amount |
90310.27 |
Total Medicare Payment Amount |
67137.15 |
Total Medicare Standardized Payment Amount |
69955.99 |
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 |
27 |
Number Of Medical Services |
691 |
Number Of Medicare Beneficiaries With Medical Services |
405 |
Total Medical Submitted Charge Amount |
178969.5 |
Total Medical Medicare Allowed Amount |
90310.27 |
Total Medical Medicare Payment Amount |
67137.15 |
Total Medical Medicare Standardized Payment Amount |
69955.99 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
80 |
Number Of Beneficiaries Age 65 to 74 |
123 |
Number Of Beneficiaries Age 75 to 84 |
134 |
Number Of Beneficiaries Age Greater 84 |
68 |
Number Of Female Beneficiaries |
210 |
Number Of Male Beneficiaries |
195 |
Number Of Non Hispanic White Beneficiaries |
286 |
Number Of Black or African American Beneficiaries |
43 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
13 |
Number Of American Indian Alaska Native Beneficiaries |
52 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
276 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
129 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
35 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
64 |
Percent Of With Chronic Kidney Disease |
61 |
Percent Of With Chronic Obstructive Pulmonary Disease |
48 |
Percent Of With Depression |
44 |
Percent Of With Diabetes |
51 |
Percent Of With Hyperlipidemia |
65 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
68 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.2762 |