National Provider Identifier [NPI]: |
1194768747 |
Last Name Of The Provider |
STAR |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1405 MONTGOMERY DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANTA ROSA |
Zip Code Of The Provider |
954054557 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
80 |
Number Of Services |
2197 |
Number Of Medicare Beneficiaries |
458 |
Total Submitted Charge Amount |
441220 |
Total Medicare Allowed Amount |
206700.5 |
Total Medicare Payment Amount |
152085.65 |
Total Medicare Standardized Payment Amount |
147825.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
274 |
Number Of Medicare Beneficiaries With Drug Services |
159 |
Total Drug Submitted ChargeAmount |
9925 |
Total Drug Medicare AllowedAmount |
5130.51 |
Total Drug Medicare PaymentAmount |
4000.24 |
Total Drug Medicare Standardized Payment Amount |
4000.24 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
76 |
Number Of Medical Services |
1923 |
Number Of Medicare Beneficiaries With Medical Services |
458 |
Total Medical Submitted Charge Amount |
431295 |
Total Medical Medicare Allowed Amount |
201569.99 |
Total Medical Medicare Payment Amount |
148085.41 |
Total Medical Medicare Standardized Payment Amount |
143825.06 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
39 |
Number Of Beneficiaries Age 65 to 74 |
204 |
Number Of Beneficiaries Age 75 to 84 |
149 |
Number Of Beneficiaries Age Greater 84 |
66 |
Number Of Female Beneficiaries |
315 |
Number Of Male Beneficiaries |
143 |
Number Of Non Hispanic White Beneficiaries |
417 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
399 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
59 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
66 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.001 |