National Provider Identifier [NPI]: |
1215997705 |
Last Name Of The Provider |
DEVALL |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
D.P.M. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1402 W AVENUE H |
Street Address 2 Of The Provider |
|
City Of The Provider |
TEMPLE |
Zip Code Of The Provider |
765045342 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Podiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
72 |
Number Of Services |
1275 |
Number Of Medicare Beneficiaries |
598 |
Total Submitted Charge Amount |
297643 |
Total Medicare Allowed Amount |
77096.51 |
Total Medicare Payment Amount |
56384.79 |
Total Medicare Standardized Payment Amount |
59094.42 |
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 |
72 |
Number Of Medical Services |
1275 |
Number Of Medicare Beneficiaries With Medical Services |
598 |
Total Medical Submitted Charge Amount |
297643 |
Total Medical Medicare Allowed Amount |
77096.51 |
Total Medical Medicare Payment Amount |
56384.79 |
Total Medical Medicare Standardized Payment Amount |
59094.42 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
151 |
Number Of Beneficiaries Age 65 to 74 |
229 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
76 |
Number Of Female Beneficiaries |
369 |
Number Of Male Beneficiaries |
229 |
Number Of Non Hispanic White Beneficiaries |
415 |
Number Of Black or African American Beneficiaries |
93 |
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 |
409 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
189 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
34 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
57 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
53 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.9684 |