National Provider Identifier [NPI]: |
1255351151 |
Last Name Of The Provider |
CRAIG |
First Name Of The Provider |
DEBRA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11370 ANDERSON ST |
Street Address 2 Of The Provider |
STE 3150 |
City Of The Provider |
LOMA LINDA |
Zip Code Of The Provider |
923543450 |
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 |
14 |
Number Of Services |
969 |
Number Of Medicare Beneficiaries |
256 |
Total Submitted Charge Amount |
157401.94 |
Total Medicare Allowed Amount |
100129.95 |
Total Medicare Payment Amount |
77956.64 |
Total Medicare Standardized Payment Amount |
76163.05 |
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 |
14 |
Number Of Medical Services |
969 |
Number Of Medicare Beneficiaries With Medical Services |
256 |
Total Medical Submitted Charge Amount |
157401.94 |
Total Medical Medicare Allowed Amount |
100129.95 |
Total Medical Medicare Payment Amount |
77956.64 |
Total Medical Medicare Standardized Payment Amount |
76163.05 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
80 |
Number Of Beneficiaries Age 65 to 74 |
86 |
Number Of Beneficiaries Age 75 to 84 |
40 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
120 |
Number Of Male Beneficiaries |
136 |
Number Of Non Hispanic White Beneficiaries |
84 |
Number Of Black or African American Beneficiaries |
34 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
119 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
62 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
194 |
Percent Of With Atrial Fibrillation |
15 |
Percent Of With Alzheimers Disease or Dementia |
27 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
54 |
Percent Of With Chronic Kidney Disease |
57 |
Percent Of With Chronic Obstructive Pulmonary Disease |
29 |
Percent Of With Depression |
29 |
Percent Of With Diabetes |
62 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
20 |
Average HCC Risk Score Of Beneficiaries |
2.6198 |