National Provider Identifier [NPI]: |
1629042403 |
Last Name Of The Provider |
JO |
First Name Of The Provider |
ROBERTO |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1200 RIVERPLACE BLVD |
Street Address 2 Of The Provider |
SUITE 620 |
City Of The Provider |
JACKSONVILLE |
Zip Code Of The Provider |
322079046 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
2273 |
Number Of Medicare Beneficiaries |
775 |
Total Submitted Charge Amount |
482624 |
Total Medicare Allowed Amount |
244295.9 |
Total Medicare Payment Amount |
190132.15 |
Total Medicare Standardized Payment Amount |
189518.64 |
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 |
25 |
Number Of Medical Services |
2273 |
Number Of Medicare Beneficiaries With Medical Services |
775 |
Total Medical Submitted Charge Amount |
482624 |
Total Medical Medicare Allowed Amount |
244295.9 |
Total Medical Medicare Payment Amount |
190132.15 |
Total Medical Medicare Standardized Payment Amount |
189518.64 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
155 |
Number Of Beneficiaries Age 65 to 74 |
216 |
Number Of Beneficiaries Age 75 to 84 |
241 |
Number Of Beneficiaries Age Greater 84 |
163 |
Number Of Female Beneficiaries |
441 |
Number Of Male Beneficiaries |
334 |
Number Of Non Hispanic White Beneficiaries |
538 |
Number Of Black or African American Beneficiaries |
199 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
21 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
536 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
239 |
Percent Of With Atrial Fibrillation |
31 |
Percent Of With Alzheimers Disease or Dementia |
26 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
16 |
Percent Of With Heart Failure |
51 |
Percent Of With Chronic Kidney Disease |
61 |
Percent Of With Chronic Obstructive Pulmonary Disease |
40 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
55 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
66 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
11 |
Percent Of With Stroke |
18 |
Average HCC Risk Score Of Beneficiaries |
2.6447 |