National Provider Identifier [NPI]: |
1740377621 |
Last Name Of The Provider |
NELSON |
First Name Of The Provider |
BRUCE |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6655 TRAVIS ST |
Street Address 2 Of The Provider |
SUITE 840 |
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770301312 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
91 |
Number Of Services |
3150 |
Number Of Medicare Beneficiaries |
483 |
Total Submitted Charge Amount |
979201.39 |
Total Medicare Allowed Amount |
607673.02 |
Total Medicare Payment Amount |
462536.52 |
Total Medicare Standardized Payment Amount |
450969.6 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
105 |
Number Of Medicare Beneficiaries With Drug Services |
30 |
Total Drug Submitted ChargeAmount |
1050 |
Total Drug Medicare AllowedAmount |
24.35 |
Total Drug Medicare PaymentAmount |
19.15 |
Total Drug Medicare Standardized Payment Amount |
19.15 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
90 |
Number Of Medical Services |
3045 |
Number Of Medicare Beneficiaries With Medical Services |
483 |
Total Medical Submitted Charge Amount |
978151.39 |
Total Medical Medicare Allowed Amount |
607648.67 |
Total Medical Medicare Payment Amount |
462517.37 |
Total Medical Medicare Standardized Payment Amount |
450950.45 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
216 |
Number Of Beneficiaries Age 75 to 84 |
162 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
174 |
Number Of Male Beneficiaries |
309 |
Number Of Non Hispanic White Beneficiaries |
459 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
16 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
9 |
Percent Of With Diabetes |
18 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.0351 |