National Provider Identifier [NPI]: |
1851409593 |
Last Name Of The Provider |
LOPES |
First Name Of The Provider |
AIMEE |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2020 GENESEE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921234219 |
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 |
25 |
Number Of Services |
239 |
Number Of Medicare Beneficiaries |
82 |
Total Submitted Charge Amount |
44585 |
Total Medicare Allowed Amount |
19575.62 |
Total Medicare Payment Amount |
13508.09 |
Total Medicare Standardized Payment Amount |
12949.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
13 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
1094 |
Total Drug Medicare AllowedAmount |
495.29 |
Total Drug Medicare PaymentAmount |
483.12 |
Total Drug Medicare Standardized Payment Amount |
483.12 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
226 |
Number Of Medicare Beneficiaries With Medical Services |
82 |
Total Medical Submitted Charge Amount |
43491 |
Total Medical Medicare Allowed Amount |
19080.33 |
Total Medical Medicare Payment Amount |
13024.97 |
Total Medical Medicare Standardized Payment Amount |
12466.58 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
37 |
Number Of Beneficiaries Age 75 to 84 |
13 |
Number Of Beneficiaries Age Greater 84 |
16 |
Number Of Female Beneficiaries |
49 |
Number Of Male Beneficiaries |
33 |
Number Of Non Hispanic White Beneficiaries |
63 |
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 |
64 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
18 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
27 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
33 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
24 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2663 |