National Provider Identifier [NPI]: |
1508943176 |
Last Name Of The Provider |
MEDINA |
First Name Of The Provider |
JUAN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4727 W PARK DR |
Street Address 2 Of The Provider |
STE A |
City Of The Provider |
ZACHARY |
Zip Code Of The Provider |
707914008 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
48 |
Number Of Services |
3048 |
Number Of Medicare Beneficiaries |
470 |
Total Submitted Charge Amount |
275958 |
Total Medicare Allowed Amount |
200179.33 |
Total Medicare Payment Amount |
150453.7 |
Total Medicare Standardized Payment Amount |
161042.8 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
188 |
Number Of Medicare Beneficiaries With Drug Services |
97 |
Total Drug Submitted ChargeAmount |
3690 |
Total Drug Medicare AllowedAmount |
2487.84 |
Total Drug Medicare PaymentAmount |
2199.49 |
Total Drug Medicare Standardized Payment Amount |
2199.49 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
43 |
Number Of Medical Services |
2860 |
Number Of Medicare Beneficiaries With Medical Services |
470 |
Total Medical Submitted Charge Amount |
272268 |
Total Medical Medicare Allowed Amount |
197691.49 |
Total Medical Medicare Payment Amount |
148254.21 |
Total Medical Medicare Standardized Payment Amount |
158843.31 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
104 |
Number Of Beneficiaries Age 65 to 74 |
136 |
Number Of Beneficiaries Age 75 to 84 |
145 |
Number Of Beneficiaries Age Greater 84 |
85 |
Number Of Female Beneficiaries |
272 |
Number Of Male Beneficiaries |
198 |
Number Of Non Hispanic White Beneficiaries |
273 |
Number Of Black or African American Beneficiaries |
|
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 |
221 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
249 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
29 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
45 |
Percent Of With Chronic Kidney Disease |
41 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
22 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
1.8988 |