National Provider Identifier [NPI]: |
1164425997 |
Last Name Of The Provider |
GONZALES |
First Name Of The Provider |
LUISITO |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
303 S NAPPANEE ST |
Street Address 2 Of The Provider |
SUITE A |
City Of The Provider |
ELKHART |
Zip Code Of The Provider |
465142066 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
108 |
Number Of Services |
9649 |
Number Of Medicare Beneficiaries |
1983 |
Total Submitted Charge Amount |
761044 |
Total Medicare Allowed Amount |
411080.38 |
Total Medicare Payment Amount |
316002.43 |
Total Medicare Standardized Payment Amount |
322981.63 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
1601 |
Number Of Medicare Beneficiaries With Drug Services |
21 |
Total Drug Submitted ChargeAmount |
2183 |
Total Drug Medicare AllowedAmount |
501.54 |
Total Drug Medicare PaymentAmount |
414.6 |
Total Drug Medicare Standardized Payment Amount |
414.6 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
104 |
Number Of Medical Services |
8048 |
Number Of Medicare Beneficiaries With Medical Services |
1983 |
Total Medical Submitted Charge Amount |
758861 |
Total Medical Medicare Allowed Amount |
410578.84 |
Total Medical Medicare Payment Amount |
315587.83 |
Total Medical Medicare Standardized Payment Amount |
322567.03 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
194 |
Number Of Beneficiaries Age 65 to 74 |
743 |
Number Of Beneficiaries Age 75 to 84 |
677 |
Number Of Beneficiaries Age Greater 84 |
369 |
Number Of Female Beneficiaries |
1103 |
Number Of Male Beneficiaries |
880 |
Number Of Non Hispanic White Beneficiaries |
1821 |
Number Of Black or African American Beneficiaries |
103 |
Number Of AsianPacific Islander Beneficiaries |
13 |
Number Of Hispanic Beneficiaries |
31 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
15 |
Number Of Beneficiaries With Medicare Only Entitlement |
1634 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
349 |
Percent Of With Atrial Fibrillation |
22 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
64 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
70 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.4298 |