National Provider Identifier [NPI]: |
1073565891 |
Last Name Of The Provider |
DAMIAN |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2210 E 29TH ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
BRYAN |
Zip Code Of The Provider |
77802 |
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 |
40 |
Number Of Services |
970 |
Number Of Medicare Beneficiaries |
298 |
Total Submitted Charge Amount |
107034.44 |
Total Medicare Allowed Amount |
63322.17 |
Total Medicare Payment Amount |
43679.8 |
Total Medicare Standardized Payment Amount |
47048.18 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
12 |
Number Of Medicare Beneficiaries With Drug Services |
11 |
Total Drug Submitted ChargeAmount |
395.5 |
Total Drug Medicare AllowedAmount |
282.99 |
Total Drug Medicare PaymentAmount |
198.78 |
Total Drug Medicare Standardized Payment Amount |
198.78 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
36 |
Number Of Medical Services |
958 |
Number Of Medicare Beneficiaries With Medical Services |
298 |
Total Medical Submitted Charge Amount |
106638.94 |
Total Medical Medicare Allowed Amount |
63039.18 |
Total Medical Medicare Payment Amount |
43481.02 |
Total Medical Medicare Standardized Payment Amount |
46849.4 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
161 |
Number Of Beneficiaries Age 75 to 84 |
70 |
Number Of Beneficiaries Age Greater 84 |
34 |
Number Of Female Beneficiaries |
145 |
Number Of Male Beneficiaries |
153 |
Number Of Non Hispanic White Beneficiaries |
219 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
47 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
279 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
19 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
13 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9031 |