National Provider Identifier [NPI]: |
1922198472 |
Last Name Of The Provider |
PHILLIPS |
First Name Of The Provider |
HAROLD |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
121 SOTOYOME ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANTA ROSA |
Zip Code Of The Provider |
954054823 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
192 |
Number Of Services |
9142 |
Number Of Medicare Beneficiaries |
3769 |
Total Submitted Charge Amount |
512606 |
Total Medicare Allowed Amount |
256864.91 |
Total Medicare Payment Amount |
208918.74 |
Total Medicare Standardized Payment Amount |
204865.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
2500 |
Number Of Medicare Beneficiaries With Drug Services |
34 |
Total Drug Submitted ChargeAmount |
6350 |
Total Drug Medicare AllowedAmount |
944.33 |
Total Drug Medicare PaymentAmount |
730.58 |
Total Drug Medicare Standardized Payment Amount |
730.58 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
189 |
Number Of Medical Services |
6642 |
Number Of Medicare Beneficiaries With Medical Services |
3769 |
Total Medical Submitted Charge Amount |
506256 |
Total Medical Medicare Allowed Amount |
255920.58 |
Total Medical Medicare Payment Amount |
208188.16 |
Total Medical Medicare Standardized Payment Amount |
204134.72 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
487 |
Number Of Beneficiaries Age 65 to 74 |
1586 |
Number Of Beneficiaries Age 75 to 84 |
1010 |
Number Of Beneficiaries Age Greater 84 |
686 |
Number Of Female Beneficiaries |
2850 |
Number Of Male Beneficiaries |
919 |
Number Of Non Hispanic White Beneficiaries |
3358 |
Number Of Black or African American Beneficiaries |
43 |
Number Of AsianPacific Islander Beneficiaries |
64 |
Number Of Hispanic Beneficiaries |
223 |
Number Of American Indian Alaska Native Beneficiaries |
37 |
Number Of Beneficiaries With Race Not Else where Classified |
44 |
Number Of Beneficiaries With Medicare Only Entitlement |
3036 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
733 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
23 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.2593 |