National Provider Identifier [NPI]: |
1760554505 |
Last Name Of The Provider |
JONES |
First Name Of The Provider |
CLOVIS |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2025 MORSE AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
SACRAMENTO |
Zip Code Of The Provider |
958252115 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
79 |
Number Of Medicare Beneficiaries |
52 |
Total Submitted Charge Amount |
10053 |
Total Medicare Allowed Amount |
2135.49 |
Total Medicare Payment Amount |
1245.04 |
Total Medicare Standardized Payment Amount |
1199.46 |
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 |
27 |
Number Of Medical Services |
79 |
Number Of Medicare Beneficiaries With Medical Services |
52 |
Total Medical Submitted Charge Amount |
10053 |
Total Medical Medicare Allowed Amount |
2135.49 |
Total Medical Medicare Payment Amount |
1245.04 |
Total Medical Medicare Standardized Payment Amount |
1199.46 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
17 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
23 |
Number Of Male Beneficiaries |
29 |
Number Of Non Hispanic White Beneficiaries |
34 |
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 |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
22 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
30 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
29 |
Percent Of With Chronic Kidney Disease |
44 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
44 |
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 |
2.1501 |