National Provider Identifier [NPI]: |
1932109196 |
Last Name Of The Provider |
CARRASCO-SANTIAGO |
First Name Of The Provider |
MANUEL |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1501 W 11TH PL |
Street Address 2 Of The Provider |
SUITE # 304 |
City Of The Provider |
BIG SPRING |
Zip Code Of The Provider |
797204119 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
57 |
Number Of Services |
3575 |
Number Of Medicare Beneficiaries |
285 |
Total Submitted Charge Amount |
529560.32 |
Total Medicare Allowed Amount |
172946.04 |
Total Medicare Payment Amount |
122687.62 |
Total Medicare Standardized Payment Amount |
128214.13 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
436 |
Number Of Medicare Beneficiaries With Drug Services |
119 |
Total Drug Submitted ChargeAmount |
18735.09 |
Total Drug Medicare AllowedAmount |
4276.09 |
Total Drug Medicare PaymentAmount |
3489.61 |
Total Drug Medicare Standardized Payment Amount |
3489.61 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
45 |
Number Of Medical Services |
3139 |
Number Of Medicare Beneficiaries With Medical Services |
285 |
Total Medical Submitted Charge Amount |
510825.23 |
Total Medical Medicare Allowed Amount |
168669.95 |
Total Medical Medicare Payment Amount |
119198.01 |
Total Medical Medicare Standardized Payment Amount |
124724.52 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
60 |
Number Of Beneficiaries Age 65 to 74 |
81 |
Number Of Beneficiaries Age 75 to 84 |
88 |
Number Of Beneficiaries Age Greater 84 |
56 |
Number Of Female Beneficiaries |
174 |
Number Of Male Beneficiaries |
111 |
Number Of Non Hispanic White Beneficiaries |
172 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
98 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
169 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
116 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
32 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
49 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
46 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.4007 |