National Provider Identifier [NPI]: |
1356507826 |
Last Name Of The Provider |
SOTO |
First Name Of The Provider |
ALLEN |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
465 W PUTNAM AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
PORTERVILLE |
Zip Code Of The Provider |
932573320 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
260 |
Number Of Medicare Beneficiaries |
212 |
Total Submitted Charge Amount |
329741 |
Total Medicare Allowed Amount |
26985.08 |
Total Medicare Payment Amount |
19993.18 |
Total Medicare Standardized Payment Amount |
23472.03 |
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 |
22 |
Number Of Medical Services |
260 |
Number Of Medicare Beneficiaries With Medical Services |
212 |
Total Medical Submitted Charge Amount |
329741 |
Total Medical Medicare Allowed Amount |
26985.08 |
Total Medical Medicare Payment Amount |
19993.18 |
Total Medical Medicare Standardized Payment Amount |
23472.03 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
79 |
Number Of Beneficiaries Age 65 to 74 |
77 |
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
24 |
Number Of Female Beneficiaries |
110 |
Number Of Male Beneficiaries |
102 |
Number Of Non Hispanic White Beneficiaries |
113 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
86 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
67 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
145 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
49 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.5575 |