National Provider Identifier [NPI]: |
1588627244 |
Last Name Of The Provider |
TABOR |
First Name Of The Provider |
ERIC |
Middle Initial Of The Provider |
N |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2780 GAUSE BLVD E |
Street Address 2 Of The Provider |
SUITE A |
City Of The Provider |
SLIDELL |
Zip Code Of The Provider |
704614149 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
85 |
Number Of Services |
10506 |
Number Of Medicare Beneficiaries |
1658 |
Total Submitted Charge Amount |
1249900.86 |
Total Medicare Allowed Amount |
615592.87 |
Total Medicare Payment Amount |
437711 |
Total Medicare Standardized Payment Amount |
476990.34 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
52 |
Number Of Medicare Beneficiaries With Drug Services |
42 |
Total Drug Submitted ChargeAmount |
1850 |
Total Drug Medicare AllowedAmount |
199.82 |
Total Drug Medicare PaymentAmount |
133.5 |
Total Drug Medicare Standardized Payment Amount |
133.5 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
81 |
Number Of Medical Services |
10454 |
Number Of Medicare Beneficiaries With Medical Services |
1658 |
Total Medical Submitted Charge Amount |
1248050.86 |
Total Medical Medicare Allowed Amount |
615393.05 |
Total Medical Medicare Payment Amount |
437577.5 |
Total Medical Medicare Standardized Payment Amount |
476856.84 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
180 |
Number Of Beneficiaries Age 65 to 74 |
775 |
Number Of Beneficiaries Age 75 to 84 |
528 |
Number Of Beneficiaries Age Greater 84 |
175 |
Number Of Female Beneficiaries |
824 |
Number Of Male Beneficiaries |
834 |
Number Of Non Hispanic White Beneficiaries |
1559 |
Number Of Black or African American Beneficiaries |
43 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
39 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
1399 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
259 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
19 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.1007 |