National Provider Identifier [NPI]: |
1215363833 |
Last Name Of The Provider |
ORTEGA |
First Name Of The Provider |
LUIS |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1211 N 16TH AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
YAKIMA |
Zip Code Of The Provider |
989021347 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
45 |
Number Of Services |
436 |
Number Of Medicare Beneficiaries |
204 |
Total Submitted Charge Amount |
126563 |
Total Medicare Allowed Amount |
28803.07 |
Total Medicare Payment Amount |
20789.3 |
Total Medicare Standardized Payment Amount |
23923.32 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
17 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
204 |
Total Drug Medicare AllowedAmount |
97.34 |
Total Drug Medicare PaymentAmount |
71.8 |
Total Drug Medicare Standardized Payment Amount |
71.8 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
44 |
Number Of Medical Services |
419 |
Number Of Medicare Beneficiaries With Medical Services |
204 |
Total Medical Submitted Charge Amount |
126359 |
Total Medical Medicare Allowed Amount |
28705.73 |
Total Medical Medicare Payment Amount |
20717.5 |
Total Medical Medicare Standardized Payment Amount |
23851.52 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
104 |
Number Of Beneficiaries Age 75 to 84 |
59 |
Number Of Beneficiaries Age Greater 84 |
14 |
Number Of Female Beneficiaries |
129 |
Number Of Male Beneficiaries |
75 |
Number Of Non Hispanic White Beneficiaries |
184 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
169 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
35 |
Percent Of With Atrial Fibrillation |
5 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
7 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8252 |