National Provider Identifier [NPI]: |
1821074014 |
Last Name Of The Provider |
KOZAM |
First Name Of The Provider |
MARC |
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 |
18111 PRINCE PHILIP DR |
Street Address 2 Of The Provider |
SUITE T-14 |
City Of The Provider |
OLNEY |
Zip Code Of The Provider |
208321513 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Gastroenterology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
751 |
Number Of Medicare Beneficiaries |
297 |
Total Submitted Charge Amount |
257073 |
Total Medicare Allowed Amount |
103186.15 |
Total Medicare Payment Amount |
81045.74 |
Total Medicare Standardized Payment Amount |
72303.62 |
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 |
27 |
Number Of Medical Services |
751 |
Number Of Medicare Beneficiaries With Medical Services |
297 |
Total Medical Submitted Charge Amount |
257073 |
Total Medical Medicare Allowed Amount |
103186.15 |
Total Medical Medicare Payment Amount |
81045.74 |
Total Medical Medicare Standardized Payment Amount |
72303.62 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
22 |
Number Of Beneficiaries Age 65 to 74 |
128 |
Number Of Beneficiaries Age 75 to 84 |
104 |
Number Of Beneficiaries Age Greater 84 |
43 |
Number Of Female Beneficiaries |
164 |
Number Of Male Beneficiaries |
133 |
Number Of Non Hispanic White Beneficiaries |
237 |
Number Of Black or African American Beneficiaries |
32 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
14 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
274 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
23 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.044 |