National Provider Identifier [NPI]: |
1679869127 |
Last Name Of The Provider |
MINNEY |
First Name Of The Provider |
ALEXANDER |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
120 E BEAUREGARD AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN ANGELO |
Zip Code Of The Provider |
769035919 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
51 |
Number Of Services |
238 |
Number Of Medicare Beneficiaries |
56 |
Total Submitted Charge Amount |
11790.87 |
Total Medicare Allowed Amount |
11546.15 |
Total Medicare Payment Amount |
9112.43 |
Total Medicare Standardized Payment Amount |
9236.07 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
21 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
598.78 |
Total Drug Medicare AllowedAmount |
570.08 |
Total Drug Medicare PaymentAmount |
556.94 |
Total Drug Medicare Standardized Payment Amount |
556.94 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
47 |
Number Of Medical Services |
217 |
Number Of Medicare Beneficiaries With Medical Services |
56 |
Total Medical Submitted Charge Amount |
11192.09 |
Total Medical Medicare Allowed Amount |
10976.07 |
Total Medical Medicare Payment Amount |
8555.49 |
Total Medical Medicare Standardized Payment Amount |
8679.13 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
15 |
Number Of Beneficiaries Age 65 to 74 |
24 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
31 |
Number Of Male Beneficiaries |
25 |
Number Of Non Hispanic White Beneficiaries |
40 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
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 |
|
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
43 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
39 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2619 |