National Provider Identifier [NPI]: |
1063724623 |
Last Name Of The Provider |
LATIF |
First Name Of The Provider |
AYAD |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
800 E DAWSON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
TYLER |
Zip Code Of The Provider |
757012036 |
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 |
14 |
Number Of Services |
1683 |
Number Of Medicare Beneficiaries |
513 |
Total Submitted Charge Amount |
292205 |
Total Medicare Allowed Amount |
150318.05 |
Total Medicare Payment Amount |
117518.9 |
Total Medicare Standardized Payment Amount |
121772.33 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
14 |
Number Of Medical Services |
1683 |
Number Of Medicare Beneficiaries With Medical Services |
513 |
Total Medical Submitted Charge Amount |
292205 |
Total Medical Medicare Allowed Amount |
150318.05 |
Total Medical Medicare Payment Amount |
117518.9 |
Total Medical Medicare Standardized Payment Amount |
121772.33 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
89 |
Number Of Beneficiaries Age 65 to 74 |
153 |
Number Of Beneficiaries Age 75 to 84 |
169 |
Number Of Beneficiaries Age Greater 84 |
102 |
Number Of Female Beneficiaries |
268 |
Number Of Male Beneficiaries |
245 |
Number Of Non Hispanic White Beneficiaries |
395 |
Number Of Black or African American Beneficiaries |
92 |
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 |
371 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
142 |
Percent Of With Atrial Fibrillation |
26 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
53 |
Percent Of With Chronic Kidney Disease |
52 |
Percent Of With Chronic Obstructive Pulmonary Disease |
37 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
49 |
Percent Of With Hyperlipidemia |
74 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
59 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
34 |
Average HCC Risk Score Of Beneficiaries |
2.2535 |