National Provider Identifier [NPI]: |
1316097751 |
Last Name Of The Provider |
TECHENTIN |
First Name Of The Provider |
ANNA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
300 FIR ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921012327 |
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 |
37 |
Number Of Services |
260 |
Number Of Medicare Beneficiaries |
55 |
Total Submitted Charge Amount |
33560 |
Total Medicare Allowed Amount |
14381.71 |
Total Medicare Payment Amount |
10295.66 |
Total Medicare Standardized Payment Amount |
9870.32 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
76 |
Number Of Medicare Beneficiaries With Drug Services |
13 |
Total Drug Submitted ChargeAmount |
2677 |
Total Drug Medicare AllowedAmount |
652.23 |
Total Drug Medicare PaymentAmount |
616.06 |
Total Drug Medicare Standardized Payment Amount |
616.06 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
184 |
Number Of Medicare Beneficiaries With Medical Services |
55 |
Total Medical Submitted Charge Amount |
30883 |
Total Medical Medicare Allowed Amount |
13729.48 |
Total Medical Medicare Payment Amount |
9679.6 |
Total Medical Medicare Standardized Payment Amount |
9254.26 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
16 |
Number Of Beneficiaries Age 65 to 74 |
26 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
39 |
Number Of Male Beneficiaries |
16 |
Number Of Non Hispanic White Beneficiaries |
35 |
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 |
36 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
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 |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
35 |
Percent Of With Hypertension |
42 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0192 |