National Provider Identifier [NPI]: |
1598829251 |
Last Name Of The Provider |
CHMIELEWSKI |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
|
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1265 HIGHWAY 54 W |
Street Address 2 Of The Provider |
SUITES 102 AND 308 |
City Of The Provider |
FAYETTEVILLE |
Zip Code Of The Provider |
302144548 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physical Therapist |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
6 |
Number Of Services |
501 |
Number Of Medicare Beneficiaries |
58 |
Total Submitted Charge Amount |
28356 |
Total Medicare Allowed Amount |
14426.53 |
Total Medicare Payment Amount |
11250.42 |
Total Medicare Standardized Payment Amount |
8469.54 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
6 |
Number Of Medical Services |
501 |
Number Of Medicare Beneficiaries With Medical Services |
58 |
Total Medical Submitted Charge Amount |
28356 |
Total Medical Medicare Allowed Amount |
14426.53 |
Total Medical Medicare Payment Amount |
11250.42 |
Total Medical Medicare Standardized Payment Amount |
8469.54 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
34 |
Number Of Beneficiaries Age 75 to 84 |
13 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
31 |
Number Of Male Beneficiaries |
27 |
Number Of Non Hispanic White Beneficiaries |
42 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
69 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7912 |