National Provider Identifier [NPI]: |
1629097035 |
Last Name Of The Provider |
COBLE |
First Name Of The Provider |
SELLAS |
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 |
600 BLUES LAKE PKWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
ROLLA |
Zip Code Of The Provider |
654018022 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
66 |
Number Of Services |
4511 |
Number Of Medicare Beneficiaries |
1724 |
Total Submitted Charge Amount |
572555.89 |
Total Medicare Allowed Amount |
236696.99 |
Total Medicare Payment Amount |
171249.52 |
Total Medicare Standardized Payment Amount |
182416.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
126 |
Number Of Medicare Beneficiaries With Drug Services |
41 |
Total Drug Submitted ChargeAmount |
2570.86 |
Total Drug Medicare AllowedAmount |
1709.56 |
Total Drug Medicare PaymentAmount |
1606.85 |
Total Drug Medicare Standardized Payment Amount |
1606.85 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
61 |
Number Of Medical Services |
4385 |
Number Of Medicare Beneficiaries With Medical Services |
1724 |
Total Medical Submitted Charge Amount |
569985.03 |
Total Medical Medicare Allowed Amount |
234987.43 |
Total Medical Medicare Payment Amount |
169642.67 |
Total Medical Medicare Standardized Payment Amount |
180810.13 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
326 |
Number Of Beneficiaries Age 65 to 74 |
577 |
Number Of Beneficiaries Age 75 to 84 |
561 |
Number Of Beneficiaries Age Greater 84 |
260 |
Number Of Female Beneficiaries |
928 |
Number Of Male Beneficiaries |
796 |
Number Of Non Hispanic White Beneficiaries |
1673 |
Number Of Black or African American Beneficiaries |
19 |
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 |
13 |
Number Of Beneficiaries With Medicare Only Entitlement |
1301 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
423 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
39 |
Percent Of With Chronic Kidney Disease |
36 |
Percent Of With Chronic Obstructive Pulmonary Disease |
34 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
57 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.6566 |