National Provider Identifier [NPI]: |
1376723759 |
Last Name Of The Provider |
PONS |
First Name Of The Provider |
MAURICIO |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
M.D |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
835 3RD AVE STE A |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHULA VISTA |
Zip Code Of The Provider |
919111352 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Ophthalmology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
59 |
Number Of Services |
11549 |
Number Of Medicare Beneficiaries |
1946 |
Total Submitted Charge Amount |
2422075 |
Total Medicare Allowed Amount |
1152414.5 |
Total Medicare Payment Amount |
840823.46 |
Total Medicare Standardized Payment Amount |
791939.38 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
337 |
Number Of Medicare Beneficiaries With Drug Services |
89 |
Total Drug Submitted ChargeAmount |
42245 |
Total Drug Medicare AllowedAmount |
20741.65 |
Total Drug Medicare PaymentAmount |
16112.7 |
Total Drug Medicare Standardized Payment Amount |
16112.7 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
54 |
Number Of Medical Services |
11212 |
Number Of Medicare Beneficiaries With Medical Services |
1946 |
Total Medical Submitted Charge Amount |
2379830 |
Total Medical Medicare Allowed Amount |
1131672.85 |
Total Medical Medicare Payment Amount |
824710.76 |
Total Medical Medicare Standardized Payment Amount |
775826.68 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
350 |
Number Of Beneficiaries Age 65 to 74 |
826 |
Number Of Beneficiaries Age 75 to 84 |
538 |
Number Of Beneficiaries Age Greater 84 |
232 |
Number Of Female Beneficiaries |
1087 |
Number Of Male Beneficiaries |
859 |
Number Of Non Hispanic White Beneficiaries |
216 |
Number Of Black or African American Beneficiaries |
42 |
Number Of AsianPacific Islander Beneficiaries |
79 |
Number Of Hispanic Beneficiaries |
1578 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
349 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
1597 |
Percent Of With Atrial Fibrillation |
5 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
65 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.6288 |