National Provider Identifier [NPI]: |
1700854296 |
Last Name Of The Provider |
DATTA |
First Name Of The Provider |
JASON |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1432 S DOBSON RD |
Street Address 2 Of The Provider |
STE 201 |
City Of The Provider |
MESA |
Zip Code Of The Provider |
85202 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
72 |
Number Of Services |
1722 |
Number Of Medicare Beneficiaries |
420 |
Total Submitted Charge Amount |
1227849.42 |
Total Medicare Allowed Amount |
317980.37 |
Total Medicare Payment Amount |
236732.92 |
Total Medicare Standardized Payment Amount |
242117.42 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
46 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
898.5 |
Total Drug Medicare AllowedAmount |
160.18 |
Total Drug Medicare PaymentAmount |
116.47 |
Total Drug Medicare Standardized Payment Amount |
116.47 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
68 |
Number Of Medical Services |
1676 |
Number Of Medicare Beneficiaries With Medical Services |
420 |
Total Medical Submitted Charge Amount |
1226950.92 |
Total Medical Medicare Allowed Amount |
317820.19 |
Total Medical Medicare Payment Amount |
236616.45 |
Total Medical Medicare Standardized Payment Amount |
242000.95 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
55 |
Number Of Beneficiaries Age 65 to 74 |
228 |
Number Of Beneficiaries Age 75 to 84 |
107 |
Number Of Beneficiaries Age Greater 84 |
30 |
Number Of Female Beneficiaries |
235 |
Number Of Male Beneficiaries |
185 |
Number Of Non Hispanic White Beneficiaries |
388 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
17 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
402 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.1056 |