National Provider Identifier [NPI]: |
1497736011 |
Last Name Of The Provider |
SELF |
First Name Of The Provider |
MAXWELL |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
403 WOODLAND HILLS BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
FORT SCOTT |
Zip Code Of The Provider |
667018798 |
State Code Of The Provider |
KS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
128 |
Number Of Services |
9744 |
Number Of Medicare Beneficiaries |
637 |
Total Submitted Charge Amount |
500670.8 |
Total Medicare Allowed Amount |
287496.13 |
Total Medicare Payment Amount |
204971.64 |
Total Medicare Standardized Payment Amount |
214257.72 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
49 |
Number Of Drug Services |
6856 |
Number Of Medicare Beneficiaries With Drug Services |
225 |
Total Drug Submitted ChargeAmount |
218792.8 |
Total Drug Medicare AllowedAmount |
95924.3 |
Total Drug Medicare PaymentAmount |
75464.04 |
Total Drug Medicare Standardized Payment Amount |
75464.04 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
79 |
Number Of Medical Services |
2888 |
Number Of Medicare Beneficiaries With Medical Services |
637 |
Total Medical Submitted Charge Amount |
281878 |
Total Medical Medicare Allowed Amount |
191571.83 |
Total Medical Medicare Payment Amount |
129507.6 |
Total Medical Medicare Standardized Payment Amount |
138793.68 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
126 |
Number Of Beneficiaries Age 65 to 74 |
217 |
Number Of Beneficiaries Age 75 to 84 |
167 |
Number Of Beneficiaries Age Greater 84 |
127 |
Number Of Female Beneficiaries |
367 |
Number Of Male Beneficiaries |
270 |
Number Of Non Hispanic White Beneficiaries |
617 |
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 |
462 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
175 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
63 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.1806 |