National Provider Identifier [NPI]: |
1306008313 |
Last Name Of The Provider |
KOHL |
First Name Of The Provider |
CHAD |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
677 N WILMOT RD |
Street Address 2 Of The Provider |
|
City Of The Provider |
TUCSON |
Zip Code Of The Provider |
857112701 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
110 |
Number Of Services |
3796 |
Number Of Medicare Beneficiaries |
1694 |
Total Submitted Charge Amount |
1266204 |
Total Medicare Allowed Amount |
297109.6 |
Total Medicare Payment Amount |
226362.46 |
Total Medicare Standardized Payment Amount |
230280.98 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
1474 |
Number Of Medicare Beneficiaries With Drug Services |
63 |
Total Drug Submitted ChargeAmount |
6359 |
Total Drug Medicare AllowedAmount |
2025.23 |
Total Drug Medicare PaymentAmount |
1564.69 |
Total Drug Medicare Standardized Payment Amount |
1564.69 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
107 |
Number Of Medical Services |
2322 |
Number Of Medicare Beneficiaries With Medical Services |
1694 |
Total Medical Submitted Charge Amount |
1259845 |
Total Medical Medicare Allowed Amount |
295084.37 |
Total Medical Medicare Payment Amount |
224797.77 |
Total Medical Medicare Standardized Payment Amount |
228716.29 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
188 |
Number Of Beneficiaries Age 65 to 74 |
832 |
Number Of Beneficiaries Age 75 to 84 |
487 |
Number Of Beneficiaries Age Greater 84 |
187 |
Number Of Female Beneficiaries |
1034 |
Number Of Male Beneficiaries |
660 |
Number Of Non Hispanic White Beneficiaries |
1471 |
Number Of Black or African American Beneficiaries |
45 |
Number Of AsianPacific Islander Beneficiaries |
17 |
Number Of Hispanic Beneficiaries |
126 |
Number Of American Indian Alaska Native Beneficiaries |
14 |
Number Of Beneficiaries With Race Not Else where Classified |
21 |
Number Of Beneficiaries With Medicare Only Entitlement |
1519 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
175 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
65 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.2823 |