National Provider Identifier [NPI]: |
1063476448 |
Last Name Of The Provider |
HANSCOM |
First Name Of The Provider |
THOMAS |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2021 SANTA MONICA BLVD |
Street Address 2 Of The Provider |
SUITE # 720E |
City Of The Provider |
SANTA MONICA |
Zip Code Of The Provider |
904042208 |
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 |
44 |
Number Of Services |
10961 |
Number Of Medicare Beneficiaries |
900 |
Total Submitted Charge Amount |
4324788.32 |
Total Medicare Allowed Amount |
2777141.02 |
Total Medicare Payment Amount |
2163259.07 |
Total Medicare Standardized Payment Amount |
2123862.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
3709 |
Number Of Medicare Beneficiaries With Drug Services |
204 |
Total Drug Submitted ChargeAmount |
2371593.32 |
Total Drug Medicare AllowedAmount |
2108439.05 |
Total Drug Medicare PaymentAmount |
1649541.73 |
Total Drug Medicare Standardized Payment Amount |
1649541.73 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
36 |
Number Of Medical Services |
7252 |
Number Of Medicare Beneficiaries With Medical Services |
900 |
Total Medical Submitted Charge Amount |
1953195 |
Total Medical Medicare Allowed Amount |
668701.97 |
Total Medical Medicare Payment Amount |
513717.34 |
Total Medical Medicare Standardized Payment Amount |
474320.57 |
Average Age Of Beneficiaries |
80 |
Number Of Beneficiaries Age Less65 |
12 |
Number Of Beneficiaries Age 65 to 74 |
254 |
Number Of Beneficiaries Age 75 to 84 |
324 |
Number Of Beneficiaries Age Greater 84 |
310 |
Number Of Female Beneficiaries |
525 |
Number Of Male Beneficiaries |
375 |
Number Of Non Hispanic White Beneficiaries |
806 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
28 |
Number Of Hispanic Beneficiaries |
28 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
841 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
59 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
8 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
44 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
1 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.314 |