National Provider Identifier [NPI]: |
1528152824 |
Last Name Of The Provider |
ENDE |
First Name Of The Provider |
MARK |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
121 S MARKET ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
PETERSBURG |
Zip Code Of The Provider |
238034217 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
21 |
Number Of Services |
3157 |
Number Of Medicare Beneficiaries |
430 |
Total Submitted Charge Amount |
250136 |
Total Medicare Allowed Amount |
223188.37 |
Total Medicare Payment Amount |
169613.1 |
Total Medicare Standardized Payment Amount |
173648.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
110 |
Number Of Medicare Beneficiaries With Drug Services |
103 |
Total Drug Submitted ChargeAmount |
3045 |
Total Drug Medicare AllowedAmount |
1339.44 |
Total Drug Medicare PaymentAmount |
1312.81 |
Total Drug Medicare Standardized Payment Amount |
1312.81 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
3047 |
Number Of Medicare Beneficiaries With Medical Services |
430 |
Total Medical Submitted Charge Amount |
247091 |
Total Medical Medicare Allowed Amount |
221848.93 |
Total Medical Medicare Payment Amount |
168300.29 |
Total Medical Medicare Standardized Payment Amount |
172335.85 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
55 |
Number Of Beneficiaries Age 65 to 74 |
158 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
75 |
Number Of Female Beneficiaries |
243 |
Number Of Male Beneficiaries |
187 |
Number Of Non Hispanic White Beneficiaries |
219 |
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 |
357 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
73 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
1.4392 |