National Provider Identifier [NPI]: |
1982673224 |
Last Name Of The Provider |
PASTORIUS |
First Name Of The Provider |
JOHN |
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 |
9055 SPRINGBROOK DR NW |
Street Address 2 Of The Provider |
|
City Of The Provider |
COON RAPIDS |
Zip Code Of The Provider |
554335841 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
80 |
Number Of Services |
1566 |
Number Of Medicare Beneficiaries |
432 |
Total Submitted Charge Amount |
207035 |
Total Medicare Allowed Amount |
77127.21 |
Total Medicare Payment Amount |
58503.33 |
Total Medicare Standardized Payment Amount |
60454.85 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
87 |
Number Of Medicare Beneficiaries With Drug Services |
68 |
Total Drug Submitted ChargeAmount |
4781 |
Total Drug Medicare AllowedAmount |
2135.09 |
Total Drug Medicare PaymentAmount |
1989.99 |
Total Drug Medicare Standardized Payment Amount |
1989.99 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
71 |
Number Of Medical Services |
1479 |
Number Of Medicare Beneficiaries With Medical Services |
430 |
Total Medical Submitted Charge Amount |
202254 |
Total Medical Medicare Allowed Amount |
74992.12 |
Total Medical Medicare Payment Amount |
56513.34 |
Total Medical Medicare Standardized Payment Amount |
58464.86 |
Average Age Of Beneficiaries |
64 |
Number Of Beneficiaries Age Less65 |
202 |
Number Of Beneficiaries Age 65 to 74 |
116 |
Number Of Beneficiaries Age 75 to 84 |
82 |
Number Of Beneficiaries Age Greater 84 |
32 |
Number Of Female Beneficiaries |
242 |
Number Of Male Beneficiaries |
190 |
Number Of Non Hispanic White Beneficiaries |
393 |
Number Of Black or African American Beneficiaries |
24 |
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 |
259 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
173 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
31 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
47 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
47 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.8132 |