National Provider Identifier [NPI]: |
1174512974 |
Last Name Of The Provider |
WEBB |
First Name Of The Provider |
TY |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
457 VISTA DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SPARTA |
Zip Code Of The Provider |
38583 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
100 |
Number Of Services |
4384 |
Number Of Medicare Beneficiaries |
659 |
Total Submitted Charge Amount |
287763 |
Total Medicare Allowed Amount |
196192.58 |
Total Medicare Payment Amount |
142584.1 |
Total Medicare Standardized Payment Amount |
152988.44 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
1558 |
Number Of Medicare Beneficiaries With Drug Services |
220 |
Total Drug Submitted ChargeAmount |
35175 |
Total Drug Medicare AllowedAmount |
21425.35 |
Total Drug Medicare PaymentAmount |
20050.95 |
Total Drug Medicare Standardized Payment Amount |
20050.95 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
87 |
Number Of Medical Services |
2826 |
Number Of Medicare Beneficiaries With Medical Services |
658 |
Total Medical Submitted Charge Amount |
252588 |
Total Medical Medicare Allowed Amount |
174767.23 |
Total Medical Medicare Payment Amount |
122533.15 |
Total Medical Medicare Standardized Payment Amount |
132937.49 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
81 |
Number Of Beneficiaries Age 65 to 74 |
298 |
Number Of Beneficiaries Age 75 to 84 |
190 |
Number Of Beneficiaries Age Greater 84 |
90 |
Number Of Female Beneficiaries |
418 |
Number Of Male Beneficiaries |
241 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
457 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
202 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
19 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.2347 |