National Provider Identifier [NPI]: |
1497703375 |
Last Name Of The Provider |
FALES |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3150 N TENAYA WAY |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
LAS VEGAS |
Zip Code Of The Provider |
891280443 |
State Code Of The Provider |
NV |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
96 |
Number Of Services |
3094 |
Number Of Medicare Beneficiaries |
363 |
Total Submitted Charge Amount |
191023.5 |
Total Medicare Allowed Amount |
126040.36 |
Total Medicare Payment Amount |
86372 |
Total Medicare Standardized Payment Amount |
86713.13 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
144 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
5545 |
Total Drug Medicare AllowedAmount |
2668.94 |
Total Drug Medicare PaymentAmount |
2271.96 |
Total Drug Medicare Standardized Payment Amount |
2271.96 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
88 |
Number Of Medical Services |
2950 |
Number Of Medicare Beneficiaries With Medical Services |
363 |
Total Medical Submitted Charge Amount |
185478.5 |
Total Medical Medicare Allowed Amount |
123371.42 |
Total Medical Medicare Payment Amount |
84100.04 |
Total Medical Medicare Standardized Payment Amount |
84441.17 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
172 |
Number Of Beneficiaries Age 75 to 84 |
114 |
Number Of Beneficiaries Age Greater 84 |
46 |
Number Of Female Beneficiaries |
172 |
Number Of Male Beneficiaries |
191 |
Number Of Non Hispanic White Beneficiaries |
299 |
Number Of Black or African American Beneficiaries |
29 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
345 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9666 |