National Provider Identifier [NPI]: |
1730270182 |
Last Name Of The Provider |
SMITH |
First Name Of The Provider |
RICHARD |
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 |
3201 UNIVERSITY DR E |
Street Address 2 Of The Provider |
SUITE 430 |
City Of The Provider |
BRYAN |
Zip Code Of The Provider |
77802 |
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 |
54 |
Number Of Services |
2242 |
Number Of Medicare Beneficiaries |
563 |
Total Submitted Charge Amount |
231982.95 |
Total Medicare Allowed Amount |
128894.2 |
Total Medicare Payment Amount |
92150.65 |
Total Medicare Standardized Payment Amount |
96895.15 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
19 |
Number Of Beneficiaries Age 65 to 74 |
287 |
Number Of Beneficiaries Age 75 to 84 |
187 |
Number Of Beneficiaries Age Greater 84 |
70 |
Number Of Female Beneficiaries |
297 |
Number Of Male Beneficiaries |
266 |
Number Of Non Hispanic White Beneficiaries |
514 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
23 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
541 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
3 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
11 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
0.898 |