National Provider Identifier [NPI]: |
1487635983 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
MARGUERITE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
275 W HERNDON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
CLOVIS |
Zip Code Of The Provider |
936120204 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
34 |
Number Of Services |
380 |
Number Of Medicare Beneficiaries |
70 |
Total Submitted Charge Amount |
40611 |
Total Medicare Allowed Amount |
24840.38 |
Total Medicare Payment Amount |
17572.5 |
Total Medicare Standardized Payment Amount |
17380.75 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
39 |
Number Of Medicare Beneficiaries With Drug Services |
28 |
Total Drug Submitted ChargeAmount |
1547 |
Total Drug Medicare AllowedAmount |
815.44 |
Total Drug Medicare PaymentAmount |
794.84 |
Total Drug Medicare Standardized Payment Amount |
794.84 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
30 |
Number Of Medical Services |
341 |
Number Of Medicare Beneficiaries With Medical Services |
70 |
Total Medical Submitted Charge Amount |
39064 |
Total Medical Medicare Allowed Amount |
24024.94 |
Total Medical Medicare Payment Amount |
16777.66 |
Total Medical Medicare Standardized Payment Amount |
16585.91 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
53 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
55 |
Number Of Male Beneficiaries |
15 |
Number Of Non Hispanic White Beneficiaries |
53 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
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 |
70 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
0 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
46 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.636 |