National Provider Identifier [NPI]: |
1528232683 |
Last Name Of The Provider |
WADDELL |
First Name Of The Provider |
RYAN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4619 KANAWHA AVE SW |
Street Address 2 Of The Provider |
PULMONARY ASSOCIATES OF CHARLESTON |
City Of The Provider |
CHARLESTON |
Zip Code Of The Provider |
253091319 |
State Code Of The Provider |
WV |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
42 |
Number Of Services |
852 |
Number Of Medicare Beneficiaries |
339 |
Total Submitted Charge Amount |
270044 |
Total Medicare Allowed Amount |
100288.06 |
Total Medicare Payment Amount |
76780.7 |
Total Medicare Standardized Payment Amount |
84653.17 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
13 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
520 |
Total Drug Medicare AllowedAmount |
450 |
Total Drug Medicare PaymentAmount |
440.97 |
Total Drug Medicare Standardized Payment Amount |
440.97 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
40 |
Number Of Medical Services |
839 |
Number Of Medicare Beneficiaries With Medical Services |
339 |
Total Medical Submitted Charge Amount |
269524 |
Total Medical Medicare Allowed Amount |
99838.06 |
Total Medical Medicare Payment Amount |
76339.73 |
Total Medical Medicare Standardized Payment Amount |
84212.2 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
85 |
Number Of Beneficiaries Age 65 to 74 |
135 |
Number Of Beneficiaries Age 75 to 84 |
90 |
Number Of Beneficiaries Age Greater 84 |
29 |
Number Of Female Beneficiaries |
175 |
Number Of Male Beneficiaries |
164 |
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 |
231 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
108 |
Percent Of With Atrial Fibrillation |
22 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
22 |
Percent Of With Heart Failure |
51 |
Percent Of With Chronic Kidney Disease |
50 |
Percent Of With Chronic Obstructive Pulmonary Disease |
63 |
Percent Of With Depression |
39 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
72 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
63 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.086 |