National Provider Identifier [NPI]: |
1437166832 |
Last Name Of The Provider |
BULLOCK |
First Name Of The Provider |
RONALD |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
415 S 28TH AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
HATTIESBURG |
Zip Code Of The Provider |
394017246 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
63 |
Number Of Services |
2512 |
Number Of Medicare Beneficiaries |
703 |
Total Submitted Charge Amount |
227073 |
Total Medicare Allowed Amount |
147135.66 |
Total Medicare Payment Amount |
101382.48 |
Total Medicare Standardized Payment Amount |
113045.55 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
400 |
Number Of Medicare Beneficiaries With Drug Services |
207 |
Total Drug Submitted ChargeAmount |
12531 |
Total Drug Medicare AllowedAmount |
5325.8 |
Total Drug Medicare PaymentAmount |
4543.23 |
Total Drug Medicare Standardized Payment Amount |
4543.23 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
49 |
Number Of Medical Services |
2112 |
Number Of Medicare Beneficiaries With Medical Services |
703 |
Total Medical Submitted Charge Amount |
214542 |
Total Medical Medicare Allowed Amount |
141809.86 |
Total Medical Medicare Payment Amount |
96839.25 |
Total Medical Medicare Standardized Payment Amount |
108502.32 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
117 |
Number Of Beneficiaries Age 65 to 74 |
307 |
Number Of Beneficiaries Age 75 to 84 |
190 |
Number Of Beneficiaries Age Greater 84 |
89 |
Number Of Female Beneficiaries |
469 |
Number Of Male Beneficiaries |
234 |
Number Of Non Hispanic White Beneficiaries |
589 |
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 |
573 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
130 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
48 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.1908 |