National Provider Identifier [NPI]: |
1932102241 |
Last Name Of The Provider |
DOUGHERTY |
First Name Of The Provider |
ROBERT |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1279 E MAIN ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
RIVERHEAD |
Zip Code Of The Provider |
119012583 |
State Code Of The Provider |
NY |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
42 |
Number Of Services |
4507 |
Number Of Medicare Beneficiaries |
1274 |
Total Submitted Charge Amount |
809501 |
Total Medicare Allowed Amount |
393032.19 |
Total Medicare Payment Amount |
294167.23 |
Total Medicare Standardized Payment Amount |
259537.1 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
125 |
Number Of Medicare Beneficiaries With Drug Services |
32 |
Total Drug Submitted ChargeAmount |
18635 |
Total Drug Medicare AllowedAmount |
6561.48 |
Total Drug Medicare PaymentAmount |
5144.16 |
Total Drug Medicare Standardized Payment Amount |
5144.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
40 |
Number Of Medical Services |
4382 |
Number Of Medicare Beneficiaries With Medical Services |
1274 |
Total Medical Submitted Charge Amount |
790866 |
Total Medical Medicare Allowed Amount |
386470.71 |
Total Medical Medicare Payment Amount |
289023.07 |
Total Medical Medicare Standardized Payment Amount |
254392.94 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
99 |
Number Of Beneficiaries Age 65 to 74 |
466 |
Number Of Beneficiaries Age 75 to 84 |
465 |
Number Of Beneficiaries Age Greater 84 |
244 |
Number Of Female Beneficiaries |
636 |
Number Of Male Beneficiaries |
638 |
Number Of Non Hispanic White Beneficiaries |
1182 |
Number Of Black or African American Beneficiaries |
49 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
1122 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
152 |
Percent Of With Atrial Fibrillation |
33 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
30 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
58 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.4699 |