National Provider Identifier [NPI]: |
1154320075 |
Last Name Of The Provider |
KEEL |
First Name Of The Provider |
DOUGLAS |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8899 UNIVERSITY CENTER LN |
Street Address 2 Of The Provider |
SUITE 150 |
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921221013 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
34 |
Number Of Services |
530 |
Number Of Medicare Beneficiaries |
90 |
Total Submitted Charge Amount |
57235 |
Total Medicare Allowed Amount |
35494.98 |
Total Medicare Payment Amount |
25339.01 |
Total Medicare Standardized Payment Amount |
24262.26 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
29 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
2315 |
Total Drug Medicare AllowedAmount |
2003.27 |
Total Drug Medicare PaymentAmount |
1570.52 |
Total Drug Medicare Standardized Payment Amount |
1570.52 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
32 |
Number Of Medical Services |
501 |
Number Of Medicare Beneficiaries With Medical Services |
90 |
Total Medical Submitted Charge Amount |
54920 |
Total Medical Medicare Allowed Amount |
33491.71 |
Total Medical Medicare Payment Amount |
23768.49 |
Total Medical Medicare Standardized Payment Amount |
22691.74 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
49 |
Number Of Beneficiaries Age 75 to 84 |
23 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
55 |
Number Of Male Beneficiaries |
35 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
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 |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
18 |
Percent Of With Diabetes |
|
Percent Of With Hyperlipidemia |
30 |
Percent Of With Hypertension |
26 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8476 |