National Provider Identifier [NPI]: |
1285636472 |
Last Name Of The Provider |
WILES |
First Name Of The Provider |
RONNIE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1619 CREIGHTON RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
PENSACOLA |
Zip Code Of The Provider |
325047152 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Nephrology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
51 |
Number Of Services |
8335 |
Number Of Medicare Beneficiaries |
1611 |
Total Submitted Charge Amount |
1761571.66 |
Total Medicare Allowed Amount |
820291.55 |
Total Medicare Payment Amount |
629229.83 |
Total Medicare Standardized Payment Amount |
628753.92 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
21 |
Number Of Medicare Beneficiaries With Drug Services |
18 |
Total Drug Submitted ChargeAmount |
352 |
Total Drug Medicare AllowedAmount |
217.7 |
Total Drug Medicare PaymentAmount |
209.87 |
Total Drug Medicare Standardized Payment Amount |
209.87 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
49 |
Number Of Medical Services |
8314 |
Number Of Medicare Beneficiaries With Medical Services |
1611 |
Total Medical Submitted Charge Amount |
1761219.66 |
Total Medical Medicare Allowed Amount |
820073.85 |
Total Medical Medicare Payment Amount |
629019.96 |
Total Medical Medicare Standardized Payment Amount |
628544.05 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
367 |
Number Of Beneficiaries Age 65 to 74 |
501 |
Number Of Beneficiaries Age 75 to 84 |
510 |
Number Of Beneficiaries Age Greater 84 |
233 |
Number Of Female Beneficiaries |
772 |
Number Of Male Beneficiaries |
839 |
Number Of Non Hispanic White Beneficiaries |
1094 |
Number Of Black or African American Beneficiaries |
438 |
Number Of AsianPacific Islander Beneficiaries |
23 |
Number Of Hispanic Beneficiaries |
24 |
Number Of American Indian Alaska Native Beneficiaries |
12 |
Number Of Beneficiaries With Race Not Else where Classified |
20 |
Number Of Beneficiaries With Medicare Only Entitlement |
1128 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
483 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
62 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
60 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
10 |
Average HCC Risk Score Of Beneficiaries |
3.4666 |