National Provider Identifier [NPI]: |
1023049863 |
Last Name Of The Provider |
CANTU |
First Name Of The Provider |
RAMON |
Middle Initial Of The Provider |
O |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
610 SOUTH AUSTIN ROAD |
Street Address 2 Of The Provider |
|
City Of The Provider |
EAGLE LAKE |
Zip Code Of The Provider |
774343202 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
21 |
Number Of Services |
393 |
Number Of Medicare Beneficiaries |
147 |
Total Submitted Charge Amount |
50328 |
Total Medicare Allowed Amount |
29850.16 |
Total Medicare Payment Amount |
22057.97 |
Total Medicare Standardized Payment Amount |
24340.54 |
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 |
21 |
Number Of Medical Services |
393 |
Number Of Medicare Beneficiaries With Medical Services |
147 |
Total Medical Submitted Charge Amount |
50328 |
Total Medical Medicare Allowed Amount |
29850.16 |
Total Medical Medicare Payment Amount |
22057.97 |
Total Medical Medicare Standardized Payment Amount |
24340.54 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
33 |
Number Of Beneficiaries Age 65 to 74 |
52 |
Number Of Beneficiaries Age 75 to 84 |
31 |
Number Of Beneficiaries Age Greater 84 |
31 |
Number Of Female Beneficiaries |
84 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
85 |
Number Of Black or African American Beneficiaries |
39 |
Number Of AsianPacific Islander Beneficiaries |
0 |
Number Of Hispanic Beneficiaries |
23 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
89 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
58 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
20 |
Percent Of With Asthma |
|
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
32 |
Percent Of With Chronic Kidney Disease |
27 |
Percent Of With Chronic Obstructive Pulmonary Disease |
33 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.6808 |