National Provider Identifier [NPI]: |
1700843117 |
Last Name Of The Provider |
GROSSMAN |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
18375 VENTURA BLVD |
Street Address 2 Of The Provider |
SUITE 640 |
City Of The Provider |
TARZANA |
Zip Code Of The Provider |
913564218 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
114 |
Number Of Services |
3453 |
Number Of Medicare Beneficiaries |
283 |
Total Submitted Charge Amount |
395628.64 |
Total Medicare Allowed Amount |
159915.5 |
Total Medicare Payment Amount |
122967.55 |
Total Medicare Standardized Payment Amount |
114252.11 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
176 |
Number Of Medicare Beneficiaries With Drug Services |
115 |
Total Drug Submitted ChargeAmount |
3640 |
Total Drug Medicare AllowedAmount |
1021.86 |
Total Drug Medicare PaymentAmount |
958.16 |
Total Drug Medicare Standardized Payment Amount |
958.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
107 |
Number Of Medical Services |
3277 |
Number Of Medicare Beneficiaries With Medical Services |
283 |
Total Medical Submitted Charge Amount |
391988.64 |
Total Medical Medicare Allowed Amount |
158893.64 |
Total Medical Medicare Payment Amount |
122009.39 |
Total Medical Medicare Standardized Payment Amount |
113293.95 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
114 |
Number Of Beneficiaries Age 75 to 84 |
97 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
166 |
Number Of Male Beneficiaries |
117 |
Number Of Non Hispanic White Beneficiaries |
263 |
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
4 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
64 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
13 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.1865 |