National Provider Identifier [NPI]: |
1629063169 |
Last Name Of The Provider |
DAVIS |
First Name Of The Provider |
TODD |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
103 N HAVEN RD |
Street Address 2 Of The Provider |
SUITE 7 |
City Of The Provider |
ELMHURST |
Zip Code Of The Provider |
601262923 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
92 |
Number Of Services |
6853 |
Number Of Medicare Beneficiaries |
931 |
Total Submitted Charge Amount |
553303.26 |
Total Medicare Allowed Amount |
509607.35 |
Total Medicare Payment Amount |
375686.74 |
Total Medicare Standardized Payment Amount |
350914.71 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
92 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
195.52 |
Total Drug Medicare AllowedAmount |
163.52 |
Total Drug Medicare PaymentAmount |
124.01 |
Total Drug Medicare Standardized Payment Amount |
124.01 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
91 |
Number Of Medical Services |
6761 |
Number Of Medicare Beneficiaries With Medical Services |
931 |
Total Medical Submitted Charge Amount |
553107.74 |
Total Medical Medicare Allowed Amount |
509443.83 |
Total Medical Medicare Payment Amount |
375562.73 |
Total Medical Medicare Standardized Payment Amount |
350790.7 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
53 |
Number Of Beneficiaries Age 65 to 74 |
418 |
Number Of Beneficiaries Age 75 to 84 |
299 |
Number Of Beneficiaries Age Greater 84 |
161 |
Number Of Female Beneficiaries |
440 |
Number Of Male Beneficiaries |
491 |
Number Of Non Hispanic White Beneficiaries |
831 |
Number Of Black or African American Beneficiaries |
14 |
Number Of AsianPacific Islander Beneficiaries |
13 |
Number Of Hispanic Beneficiaries |
59 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
855 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
76 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
11 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.0893 |