National Provider Identifier [NPI]: |
1881699908 |
Last Name Of The Provider |
KNOWLES |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
604 SEVILLE DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
MOUNT VERNON |
Zip Code Of The Provider |
628647001 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
108 |
Number Of Services |
24366.8 |
Number Of Medicare Beneficiaries |
931 |
Total Submitted Charge Amount |
1973080.96 |
Total Medicare Allowed Amount |
638944.21 |
Total Medicare Payment Amount |
495168.08 |
Total Medicare Standardized Payment Amount |
508871.86 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
19568.8 |
Number Of Medicare Beneficiaries With Drug Services |
147 |
Total Drug Submitted ChargeAmount |
364919.6 |
Total Drug Medicare AllowedAmount |
212842.53 |
Total Drug Medicare PaymentAmount |
166538.84 |
Total Drug Medicare Standardized Payment Amount |
166538.84 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
98 |
Number Of Medical Services |
4798 |
Number Of Medicare Beneficiaries With Medical Services |
931 |
Total Medical Submitted Charge Amount |
1608161.36 |
Total Medical Medicare Allowed Amount |
426101.68 |
Total Medical Medicare Payment Amount |
328629.24 |
Total Medical Medicare Standardized Payment Amount |
342333.02 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
71 |
Number Of Beneficiaries Age 65 to 74 |
398 |
Number Of Beneficiaries Age 75 to 84 |
342 |
Number Of Beneficiaries Age Greater 84 |
120 |
Number Of Female Beneficiaries |
219 |
Number Of Male Beneficiaries |
712 |
Number Of Non Hispanic White Beneficiaries |
901 |
Number Of Black or African American Beneficiaries |
14 |
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 |
826 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
105 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
3 |
Percent Of With Cancer |
30 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.2593 |