National Provider Identifier [NPI]: |
1427015726 |
Last Name Of The Provider |
VARGAS |
First Name Of The Provider |
TEODORO |
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 |
319 N 1ST ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
PACIFIC |
Zip Code Of The Provider |
630691505 |
State Code Of The Provider |
MO |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
964 |
Number Of Medicare Beneficiaries |
237 |
Total Submitted Charge Amount |
154684 |
Total Medicare Allowed Amount |
70633.9 |
Total Medicare Payment Amount |
51975.13 |
Total Medicare Standardized Payment Amount |
57083.76 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
24 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
881 |
Total Drug Medicare AllowedAmount |
471.06 |
Total Drug Medicare PaymentAmount |
459.53 |
Total Drug Medicare Standardized Payment Amount |
459.53 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
30 |
Number Of Medical Services |
940 |
Number Of Medicare Beneficiaries With Medical Services |
237 |
Total Medical Submitted Charge Amount |
153803 |
Total Medical Medicare Allowed Amount |
70162.84 |
Total Medical Medicare Payment Amount |
51515.6 |
Total Medical Medicare Standardized Payment Amount |
56624.23 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
44 |
Number Of Beneficiaries Age 65 to 74 |
100 |
Number Of Beneficiaries Age 75 to 84 |
62 |
Number Of Beneficiaries Age Greater 84 |
31 |
Number Of Female Beneficiaries |
134 |
Number Of Male Beneficiaries |
103 |
Number Of Non Hispanic White Beneficiaries |
220 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
174 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
63 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
|
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.3298 |