National Provider Identifier [NPI]: |
1588684062 |
Last Name Of The Provider |
VILLAREAL |
First Name Of The Provider |
JAMES |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
5770 FASHION BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
MURRAY |
Zip Code Of The Provider |
841076548 |
State Code Of The Provider |
UT |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
629 |
Number Of Medicare Beneficiaries |
323 |
Total Submitted Charge Amount |
177992.29 |
Total Medicare Allowed Amount |
59595.62 |
Total Medicare Payment Amount |
43131.45 |
Total Medicare Standardized Payment Amount |
46158.05 |
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 |
35 |
Number Of Medical Services |
629 |
Number Of Medicare Beneficiaries With Medical Services |
323 |
Total Medical Submitted Charge Amount |
177992.29 |
Total Medical Medicare Allowed Amount |
59595.62 |
Total Medical Medicare Payment Amount |
43131.45 |
Total Medical Medicare Standardized Payment Amount |
46158.05 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
75 |
Number Of Beneficiaries Age 65 to 74 |
90 |
Number Of Beneficiaries Age 75 to 84 |
99 |
Number Of Beneficiaries Age Greater 84 |
59 |
Number Of Female Beneficiaries |
181 |
Number Of Male Beneficiaries |
142 |
Number Of Non Hispanic White Beneficiaries |
276 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
13 |
Number Of Hispanic Beneficiaries |
23 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
245 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
78 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
33 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
51 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.7711 |