National Provider Identifier [NPI]: |
1720098775 |
Last Name Of The Provider |
DALE |
First Name Of The Provider |
BARRY |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11234 ANDERSON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
LOMA LINDA |
Zip Code Of The Provider |
923542804 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Anesthesiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
65 |
Number Of Services |
291 |
Number Of Medicare Beneficiaries |
236 |
Total Submitted Charge Amount |
291095 |
Total Medicare Allowed Amount |
59640.58 |
Total Medicare Payment Amount |
46026.97 |
Total Medicare Standardized Payment Amount |
47391.22 |
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 |
65 |
Number Of Medical Services |
291 |
Number Of Medicare Beneficiaries With Medical Services |
236 |
Total Medical Submitted Charge Amount |
291095 |
Total Medical Medicare Allowed Amount |
59640.58 |
Total Medical Medicare Payment Amount |
46026.97 |
Total Medical Medicare Standardized Payment Amount |
47391.22 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
13 |
Number Of Beneficiaries Age 65 to 74 |
120 |
Number Of Beneficiaries Age 75 to 84 |
76 |
Number Of Beneficiaries Age Greater 84 |
27 |
Number Of Female Beneficiaries |
117 |
Number Of Male Beneficiaries |
119 |
Number Of Non Hispanic White Beneficiaries |
204 |
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 |
224 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
22 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
25 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.3284 |