National Provider Identifier [NPI]: |
1417146390 |
Last Name Of The Provider |
LALA |
First Name Of The Provider |
CHAD |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2401 S 31ST ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
TEMPLE |
Zip Code Of The Provider |
765080001 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
5 |
Number Of Services |
169 |
Number Of Medicare Beneficiaries |
162 |
Total Submitted Charge Amount |
64728 |
Total Medicare Allowed Amount |
27565.45 |
Total Medicare Payment Amount |
21492.33 |
Total Medicare Standardized Payment Amount |
26136.3 |
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 |
5 |
Number Of Medical Services |
169 |
Number Of Medicare Beneficiaries With Medical Services |
162 |
Total Medical Submitted Charge Amount |
64728 |
Total Medical Medicare Allowed Amount |
27565.45 |
Total Medical Medicare Payment Amount |
21492.33 |
Total Medical Medicare Standardized Payment Amount |
26136.3 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
53 |
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
20 |
Number Of Female Beneficiaries |
90 |
Number Of Male Beneficiaries |
72 |
Number Of Non Hispanic White Beneficiaries |
117 |
Number Of Black or African American Beneficiaries |
29 |
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 |
97 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
65 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
16 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
62 |
Percent Of With Chronic Kidney Disease |
60 |
Percent Of With Chronic Obstructive Pulmonary Disease |
30 |
Percent Of With Depression |
48 |
Percent Of With Diabetes |
52 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
59 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
22 |
Average HCC Risk Score Of Beneficiaries |
2.5653 |