National Provider Identifier [NPI]: |
1629071709 |
Last Name Of The Provider |
O'DONNELL |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3201 S LOOP 256 |
Street Address 2 Of The Provider |
STE 170 |
City Of The Provider |
PALESTINE |
Zip Code Of The Provider |
758016901 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
271 |
Number Of Services |
17438 |
Number Of Medicare Beneficiaries |
1125 |
Total Submitted Charge Amount |
1533725.96 |
Total Medicare Allowed Amount |
586204.03 |
Total Medicare Payment Amount |
457387.08 |
Total Medicare Standardized Payment Amount |
485229.52 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
20 |
Number Of Drug Services |
1900 |
Number Of Medicare Beneficiaries With Drug Services |
397 |
Total Drug Submitted ChargeAmount |
25500.88 |
Total Drug Medicare AllowedAmount |
17394.66 |
Total Drug Medicare PaymentAmount |
14759.05 |
Total Drug Medicare Standardized Payment Amount |
14759.05 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
251 |
Number Of Medical Services |
15538 |
Number Of Medicare Beneficiaries With Medical Services |
1125 |
Total Medical Submitted Charge Amount |
1508225.08 |
Total Medical Medicare Allowed Amount |
568809.37 |
Total Medical Medicare Payment Amount |
442628.03 |
Total Medical Medicare Standardized Payment Amount |
470470.47 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
128 |
Number Of Beneficiaries Age 65 to 74 |
455 |
Number Of Beneficiaries Age 75 to 84 |
364 |
Number Of Beneficiaries Age Greater 84 |
178 |
Number Of Female Beneficiaries |
681 |
Number Of Male Beneficiaries |
444 |
Number Of Non Hispanic White Beneficiaries |
988 |
Number Of Black or African American Beneficiaries |
106 |
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 |
960 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
165 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
16 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
21 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.171 |