National Provider Identifier [NPI]: |
1699791954 |
Last Name Of The Provider |
KARL |
First Name Of The Provider |
GARY |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
600 S RANCHO DR |
Street Address 2 Of The Provider |
#113 |
City Of The Provider |
LAS VEGAS |
Zip Code Of The Provider |
891064867 |
State Code Of The Provider |
NV |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
465 |
Number Of Medicare Beneficiaries |
58 |
Total Submitted Charge Amount |
230873.5 |
Total Medicare Allowed Amount |
31933.32 |
Total Medicare Payment Amount |
21698.44 |
Total Medicare Standardized Payment Amount |
21068.01 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
28 |
Number Of Medicare Beneficiaries With Drug Services |
15 |
Total Drug Submitted ChargeAmount |
460 |
Total Drug Medicare AllowedAmount |
80.15 |
Total Drug Medicare PaymentAmount |
60.04 |
Total Drug Medicare Standardized Payment Amount |
60.04 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
437 |
Number Of Medicare Beneficiaries With Medical Services |
58 |
Total Medical Submitted Charge Amount |
230413.5 |
Total Medical Medicare Allowed Amount |
31853.17 |
Total Medical Medicare Payment Amount |
21638.4 |
Total Medical Medicare Standardized Payment Amount |
21007.97 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
33 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
26 |
Number Of Male Beneficiaries |
32 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
62 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8675 |