National Provider Identifier [NPI]: |
1275852717 |
Last Name Of The Provider |
VO |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1301 W 38TH ST |
Street Address 2 Of The Provider |
STE 601 |
City Of The Provider |
AUSTIN |
Zip Code Of The Provider |
787051069 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
482 |
Number Of Medicare Beneficiaries |
206 |
Total Submitted Charge Amount |
38114.89 |
Total Medicare Allowed Amount |
38072.99 |
Total Medicare Payment Amount |
27671.82 |
Total Medicare Standardized Payment Amount |
27617.54 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
16 |
Number Of Medicare Beneficiaries With Drug Services |
16 |
Total Drug Submitted ChargeAmount |
255.1 |
Total Drug Medicare AllowedAmount |
254.66 |
Total Drug Medicare PaymentAmount |
249.04 |
Total Drug Medicare Standardized Payment Amount |
249.04 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
466 |
Number Of Medicare Beneficiaries With Medical Services |
206 |
Total Medical Submitted Charge Amount |
37859.79 |
Total Medical Medicare Allowed Amount |
37818.33 |
Total Medical Medicare Payment Amount |
27422.78 |
Total Medical Medicare Standardized Payment Amount |
27368.5 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
102 |
Number Of Beneficiaries Age 75 to 84 |
56 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
124 |
Number Of Male Beneficiaries |
82 |
Number Of Non Hispanic White Beneficiaries |
182 |
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 |
192 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
14 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
26 |
Percent Of With Diabetes |
17 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
57 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
49 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0199 |