National Provider Identifier [NPI]: |
1639120868 |
Last Name Of The Provider |
LARAYA |
First Name Of The Provider |
JOSE |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3860 NEW COVINGTON PIKE |
Street Address 2 Of The Provider |
101 |
City Of The Provider |
MEMPHIS |
Zip Code Of The Provider |
381282506 |
State Code Of The Provider |
TN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
44 |
Number Of Services |
646 |
Number Of Medicare Beneficiaries |
93 |
Total Submitted Charge Amount |
61297 |
Total Medicare Allowed Amount |
41326.49 |
Total Medicare Payment Amount |
30969.31 |
Total Medicare Standardized Payment Amount |
33391.84 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
9 |
Number Of Drug Services |
41 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
1049 |
Total Drug Medicare AllowedAmount |
248.24 |
Total Drug Medicare PaymentAmount |
231 |
Total Drug Medicare Standardized Payment Amount |
231 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
35 |
Number Of Medical Services |
605 |
Number Of Medicare Beneficiaries With Medical Services |
93 |
Total Medical Submitted Charge Amount |
60248 |
Total Medical Medicare Allowed Amount |
41078.25 |
Total Medical Medicare Payment Amount |
30738.31 |
Total Medical Medicare Standardized Payment Amount |
33160.84 |
Average Age Of Beneficiaries |
59 |
Number Of Beneficiaries Age Less65 |
51 |
Number Of Beneficiaries Age 65 to 74 |
22 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
56 |
Number Of Male Beneficiaries |
37 |
Number Of Non Hispanic White Beneficiaries |
31 |
Number Of Black or African American Beneficiaries |
41 |
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 |
29 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
64 |
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 |
27 |
Percent Of With Chronic Kidney Disease |
31 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
39 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
26 |
Percent Of With Schizophrenia Other PsychoticDisorders |
14 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.3748 |