National Provider Identifier [NPI]: |
1023213873 |
Last Name Of The Provider |
GOLDBURT |
First Name Of The Provider |
VALERIE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
58-47 188TH STREET |
Street Address 2 Of The Provider |
|
City Of The Provider |
FRESH MEADOWS |
Zip Code Of The Provider |
11365 |
State Code Of The Provider |
NY |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
39 |
Number Of Services |
1853 |
Number Of Medicare Beneficiaries |
360 |
Total Submitted Charge Amount |
265190 |
Total Medicare Allowed Amount |
155957.97 |
Total Medicare Payment Amount |
117636.02 |
Total Medicare Standardized Payment Amount |
100701.65 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
35 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
2175 |
Total Drug Medicare AllowedAmount |
1038.16 |
Total Drug Medicare PaymentAmount |
812.75 |
Total Drug Medicare Standardized Payment Amount |
812.75 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
37 |
Number Of Medical Services |
1818 |
Number Of Medicare Beneficiaries With Medical Services |
360 |
Total Medical Submitted Charge Amount |
263015 |
Total Medical Medicare Allowed Amount |
154919.81 |
Total Medical Medicare Payment Amount |
116823.27 |
Total Medical Medicare Standardized Payment Amount |
99888.9 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
182 |
Number Of Beneficiaries Age 75 to 84 |
80 |
Number Of Beneficiaries Age Greater 84 |
38 |
Number Of Female Beneficiaries |
221 |
Number Of Male Beneficiaries |
139 |
Number Of Non Hispanic White Beneficiaries |
329 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
287 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
73 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.0922 |