National Provider Identifier [NPI]: |
1134230931 |
Last Name Of The Provider |
HARLE |
First Name Of The Provider |
BRIAN |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7711 LOUIS PASTEUR |
Street Address 2 Of The Provider |
#200 |
City Of The Provider |
SAN ANTONIO |
Zip Code Of The Provider |
78229 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Obstetrics/Gynecology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
33 |
Number Of Services |
415 |
Number Of Medicare Beneficiaries |
148 |
Total Submitted Charge Amount |
39839 |
Total Medicare Allowed Amount |
21572.89 |
Total Medicare Payment Amount |
18079.25 |
Total Medicare Standardized Payment Amount |
19851.34 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
91 |
Number Of Beneficiaries Age 75 to 84 |
38 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
148 |
Number Of Male Beneficiaries |
0 |
Number Of Non Hispanic White Beneficiaries |
123 |
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 |
8 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
14 |
Percent Of With Diabetes |
14 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
18 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.786 |