National Provider Identifier [NPI]: |
1932356789 |
Last Name Of The Provider |
PENDLETON |
First Name Of The Provider |
RUSSELL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
DPM |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6076 AZLE AVE |
Street Address 2 Of The Provider |
#200 |
City Of The Provider |
LAKE WORTH |
Zip Code Of The Provider |
761352627 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Podiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
63 |
Number Of Services |
2573 |
Number Of Medicare Beneficiaries |
564 |
Total Submitted Charge Amount |
319988.12 |
Total Medicare Allowed Amount |
140537.41 |
Total Medicare Payment Amount |
100460.28 |
Total Medicare Standardized Payment Amount |
102732.78 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
177 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
8430 |
Total Drug Medicare AllowedAmount |
3604.96 |
Total Drug Medicare PaymentAmount |
2824.3 |
Total Drug Medicare Standardized Payment Amount |
2824.3 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
61 |
Number Of Medical Services |
2396 |
Number Of Medicare Beneficiaries With Medical Services |
564 |
Total Medical Submitted Charge Amount |
311558.12 |
Total Medical Medicare Allowed Amount |
136932.45 |
Total Medical Medicare Payment Amount |
97635.98 |
Total Medical Medicare Standardized Payment Amount |
99908.48 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
66 |
Number Of Beneficiaries Age 65 to 74 |
201 |
Number Of Beneficiaries Age 75 to 84 |
175 |
Number Of Beneficiaries Age Greater 84 |
122 |
Number Of Female Beneficiaries |
392 |
Number Of Male Beneficiaries |
172 |
Number Of Non Hispanic White Beneficiaries |
507 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
37 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
377 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
187 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
34 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
38 |
Percent Of With Chronic Kidney Disease |
34 |
Percent Of With Chronic Obstructive Pulmonary Disease |
26 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
47 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.6692 |