National Provider Identifier [NPI]: |
1144333196 |
Last Name Of The Provider |
FIGUEROA |
First Name Of The Provider |
EVELYN |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
|
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1740 W TAYLOR ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHICAGO |
Zip Code Of The Provider |
606127232 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
146 |
Number Of Medicare Beneficiaries |
48 |
Total Submitted Charge Amount |
24268 |
Total Medicare Allowed Amount |
11065.41 |
Total Medicare Payment Amount |
7990.08 |
Total Medicare Standardized Payment Amount |
7603.86 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
20 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
810 |
Total Drug Medicare AllowedAmount |
431.84 |
Total Drug Medicare PaymentAmount |
412.04 |
Total Drug Medicare Standardized Payment Amount |
412.04 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
16 |
Number Of Medical Services |
126 |
Number Of Medicare Beneficiaries With Medical Services |
48 |
Total Medical Submitted Charge Amount |
23458 |
Total Medical Medicare Allowed Amount |
10633.57 |
Total Medical Medicare Payment Amount |
7578.04 |
Total Medical Medicare Standardized Payment Amount |
7191.82 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
16 |
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
33 |
Number Of Male Beneficiaries |
15 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
26 |
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 |
18 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
30 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
35 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
31 |
Percent Of With Diabetes |
46 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
54 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.5143 |