National Provider Identifier [NPI]: |
1578526034 |
Last Name Of The Provider |
KANLIC |
First Name Of The Provider |
ENES |
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 |
4801 ALBERTA AVE. |
Street Address 2 Of The Provider |
|
City Of The Provider |
EL PASO |
Zip Code Of The Provider |
79905 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
53 |
Number Of Services |
363 |
Number Of Medicare Beneficiaries |
119 |
Total Submitted Charge Amount |
184561 |
Total Medicare Allowed Amount |
59839.75 |
Total Medicare Payment Amount |
43664.29 |
Total Medicare Standardized Payment Amount |
47496.64 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
19 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
115 |
Total Drug Medicare AllowedAmount |
55.6 |
Total Drug Medicare PaymentAmount |
37.13 |
Total Drug Medicare Standardized Payment Amount |
37.13 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
52 |
Number Of Medical Services |
344 |
Number Of Medicare Beneficiaries With Medical Services |
119 |
Total Medical Submitted Charge Amount |
184446 |
Total Medical Medicare Allowed Amount |
59784.15 |
Total Medical Medicare Payment Amount |
43627.16 |
Total Medical Medicare Standardized Payment Amount |
47459.51 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
24 |
Number Of Beneficiaries Age 65 to 74 |
47 |
Number Of Beneficiaries Age 75 to 84 |
30 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
75 |
Number Of Male Beneficiaries |
44 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
94 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
51 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
68 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
|
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
59 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
23 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
71 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8296 |