National Provider Identifier [NPI]: |
1568468015 |
Last Name Of The Provider |
CARD |
First Name Of The Provider |
EDWIN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
515 E GRANT ST |
Street Address 2 Of The Provider |
SUITE 211 |
City Of The Provider |
MACOMB |
Zip Code Of The Provider |
614553368 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
113 |
Number Of Services |
869 |
Number Of Medicare Beneficiaries |
442 |
Total Submitted Charge Amount |
508400 |
Total Medicare Allowed Amount |
126266.37 |
Total Medicare Payment Amount |
95463.25 |
Total Medicare Standardized Payment Amount |
99094.49 |
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 |
113 |
Number Of Medical Services |
869 |
Number Of Medicare Beneficiaries With Medical Services |
442 |
Total Medical Submitted Charge Amount |
508400 |
Total Medical Medicare Allowed Amount |
126266.37 |
Total Medical Medicare Payment Amount |
95463.25 |
Total Medical Medicare Standardized Payment Amount |
99094.49 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
49 |
Number Of Beneficiaries Age 65 to 74 |
149 |
Number Of Beneficiaries Age 75 to 84 |
156 |
Number Of Beneficiaries Age Greater 84 |
88 |
Number Of Female Beneficiaries |
272 |
Number Of Male Beneficiaries |
170 |
Number Of Non Hispanic White Beneficiaries |
428 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
346 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
96 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.2057 |