National Provider Identifier [NPI]: |
1750316410 |
Last Name Of The Provider |
BROCK |
First Name Of The Provider |
SONYA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1101 ALMA ST |
Street Address 2 Of The Provider |
SUITE 104 |
City Of The Provider |
TOMBALL |
Zip Code Of The Provider |
773754554 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
34 |
Number Of Services |
463 |
Number Of Medicare Beneficiaries |
93 |
Total Submitted Charge Amount |
50071 |
Total Medicare Allowed Amount |
20022.64 |
Total Medicare Payment Amount |
12454.64 |
Total Medicare Standardized Payment Amount |
12542.24 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
171 |
Number Of Medicare Beneficiaries With Drug Services |
18 |
Total Drug Submitted ChargeAmount |
1444 |
Total Drug Medicare AllowedAmount |
551.41 |
Total Drug Medicare PaymentAmount |
527.92 |
Total Drug Medicare Standardized Payment Amount |
527.92 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
292 |
Number Of Medicare Beneficiaries With Medical Services |
93 |
Total Medical Submitted Charge Amount |
48627 |
Total Medical Medicare Allowed Amount |
19471.23 |
Total Medical Medicare Payment Amount |
11926.72 |
Total Medical Medicare Standardized Payment Amount |
12014.32 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
14 |
Number Of Beneficiaries Age 65 to 74 |
41 |
Number Of Beneficiaries Age 75 to 84 |
21 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
61 |
Number Of Male Beneficiaries |
32 |
Number Of Non Hispanic White Beneficiaries |
81 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
81 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1719 |