National Provider Identifier [NPI]: |
1518133693 |
Last Name Of The Provider |
CARTER |
First Name Of The Provider |
CHRISTIAN |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
PAC |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 COVEY CT |
Street Address 2 Of The Provider |
|
City Of The Provider |
IONE |
Zip Code Of The Provider |
956405226 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
280 |
Number Of Medicare Beneficiaries |
225 |
Total Submitted Charge Amount |
203047 |
Total Medicare Allowed Amount |
27077.97 |
Total Medicare Payment Amount |
20321.6 |
Total Medicare Standardized Payment Amount |
23935.83 |
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 |
23 |
Number Of Medical Services |
280 |
Number Of Medicare Beneficiaries With Medical Services |
225 |
Total Medical Submitted Charge Amount |
203047 |
Total Medical Medicare Allowed Amount |
27077.97 |
Total Medical Medicare Payment Amount |
20321.6 |
Total Medical Medicare Standardized Payment Amount |
23935.83 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
70 |
Number Of Beneficiaries Age 65 to 74 |
72 |
Number Of Beneficiaries Age 75 to 84 |
48 |
Number Of Beneficiaries Age Greater 84 |
35 |
Number Of Female Beneficiaries |
120 |
Number Of Male Beneficiaries |
105 |
Number Of Non Hispanic White Beneficiaries |
170 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
39 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
126 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
99 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
26 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
24 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
70 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.7516 |