National Provider Identifier [NPI]: |
1003823550 |
Last Name Of The Provider |
RIDDLE |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
869 W LACEY BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
HANFORD |
Zip Code Of The Provider |
932304328 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
85 |
Number Of Services |
4175 |
Number Of Medicare Beneficiaries |
377 |
Total Submitted Charge Amount |
286279 |
Total Medicare Allowed Amount |
174233.66 |
Total Medicare Payment Amount |
123218.05 |
Total Medicare Standardized Payment Amount |
121233.96 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
18 |
Number Of Drug Services |
1412 |
Number Of Medicare Beneficiaries With Drug Services |
150 |
Total Drug Submitted ChargeAmount |
49322 |
Total Drug Medicare AllowedAmount |
2050.47 |
Total Drug Medicare PaymentAmount |
1638.53 |
Total Drug Medicare Standardized Payment Amount |
1638.53 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
67 |
Number Of Medical Services |
2763 |
Number Of Medicare Beneficiaries With Medical Services |
377 |
Total Medical Submitted Charge Amount |
236957 |
Total Medical Medicare Allowed Amount |
172183.19 |
Total Medical Medicare Payment Amount |
121579.52 |
Total Medical Medicare Standardized Payment Amount |
119595.43 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
161 |
Number Of Beneficiaries Age 75 to 84 |
105 |
Number Of Beneficiaries Age Greater 84 |
51 |
Number Of Female Beneficiaries |
203 |
Number Of Male Beneficiaries |
174 |
Number Of Non Hispanic White Beneficiaries |
241 |
Number Of Black or African American Beneficiaries |
15 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
102 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
265 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
112 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
59 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.0429 |