National Provider Identifier [NPI]: |
1104813435 |
Last Name Of The Provider |
WHITE |
First Name Of The Provider |
THOMAS |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1221 N HIGHLAND AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
AURORA |
Zip Code Of The Provider |
605061404 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
97 |
Number Of Services |
1312 |
Number Of Medicare Beneficiaries |
409 |
Total Submitted Charge Amount |
609074.5 |
Total Medicare Allowed Amount |
175570.69 |
Total Medicare Payment Amount |
131916.73 |
Total Medicare Standardized Payment Amount |
122072.91 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
273 |
Number Of Medicare Beneficiaries With Drug Services |
135 |
Total Drug Submitted ChargeAmount |
20415 |
Total Drug Medicare AllowedAmount |
12162.04 |
Total Drug Medicare PaymentAmount |
9240.2 |
Total Drug Medicare Standardized Payment Amount |
9240.2 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
95 |
Number Of Medical Services |
1039 |
Number Of Medicare Beneficiaries With Medical Services |
409 |
Total Medical Submitted Charge Amount |
588659.5 |
Total Medical Medicare Allowed Amount |
163408.65 |
Total Medical Medicare Payment Amount |
122676.53 |
Total Medical Medicare Standardized Payment Amount |
112832.71 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
55 |
Number Of Beneficiaries Age 65 to 74 |
208 |
Number Of Beneficiaries Age 75 to 84 |
102 |
Number Of Beneficiaries Age Greater 84 |
44 |
Number Of Female Beneficiaries |
234 |
Number Of Male Beneficiaries |
175 |
Number Of Non Hispanic White Beneficiaries |
318 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
50 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
346 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
63 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
65 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.192 |