National Provider Identifier [NPI]: |
1063664076 |
Last Name Of The Provider |
RESTREPO |
First Name Of The Provider |
DIEGO |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5012 S US HIGHWAY 75 |
Street Address 2 Of The Provider |
SUITE 300 |
City Of The Provider |
DENISON |
Zip Code Of The Provider |
750204587 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
77 |
Number Of Services |
4559 |
Number Of Medicare Beneficiaries |
346 |
Total Submitted Charge Amount |
313888.75 |
Total Medicare Allowed Amount |
124374.36 |
Total Medicare Payment Amount |
98883.4 |
Total Medicare Standardized Payment Amount |
103825.09 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
926 |
Number Of Medicare Beneficiaries With Drug Services |
176 |
Total Drug Submitted ChargeAmount |
23674 |
Total Drug Medicare AllowedAmount |
6400.24 |
Total Drug Medicare PaymentAmount |
5609.72 |
Total Drug Medicare Standardized Payment Amount |
5609.72 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
68 |
Number Of Medical Services |
3633 |
Number Of Medicare Beneficiaries With Medical Services |
346 |
Total Medical Submitted Charge Amount |
290214.75 |
Total Medical Medicare Allowed Amount |
117974.12 |
Total Medical Medicare Payment Amount |
93273.68 |
Total Medical Medicare Standardized Payment Amount |
98215.37 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
72 |
Number Of Beneficiaries Age 65 to 74 |
180 |
Number Of Beneficiaries Age 75 to 84 |
69 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
181 |
Number Of Male Beneficiaries |
165 |
Number Of Non Hispanic White Beneficiaries |
308 |
Number Of Black or African American Beneficiaries |
16 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
11 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
278 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
68 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.4034 |