National Provider Identifier [NPI]: |
1689770687 |
Last Name Of The Provider |
WINNER |
First Name Of The Provider |
JAY |
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 |
215 PESETAS LN |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANTA BARBARA |
Zip Code Of The Provider |
931101416 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
43 |
Number Of Services |
1035 |
Number Of Medicare Beneficiaries |
208 |
Total Submitted Charge Amount |
179137 |
Total Medicare Allowed Amount |
89374.47 |
Total Medicare Payment Amount |
69161.89 |
Total Medicare Standardized Payment Amount |
66935.46 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
148 |
Number Of Medicare Beneficiaries With Drug Services |
93 |
Total Drug Submitted ChargeAmount |
33176 |
Total Drug Medicare AllowedAmount |
11858.48 |
Total Drug Medicare PaymentAmount |
11609.38 |
Total Drug Medicare Standardized Payment Amount |
11609.38 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
34 |
Number Of Medical Services |
887 |
Number Of Medicare Beneficiaries With Medical Services |
208 |
Total Medical Submitted Charge Amount |
145961 |
Total Medical Medicare Allowed Amount |
77515.99 |
Total Medical Medicare Payment Amount |
57552.51 |
Total Medical Medicare Standardized Payment Amount |
55326.08 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
111 |
Number Of Beneficiaries Age 75 to 84 |
63 |
Number Of Beneficiaries Age Greater 84 |
15 |
Number Of Female Beneficiaries |
84 |
Number Of Male Beneficiaries |
124 |
Number Of Non Hispanic White Beneficiaries |
168 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
26 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
188 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
20 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
31 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
63 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.1116 |