National Provider Identifier [NPI]: |
1023297702 |
Last Name Of The Provider |
CRUZ-LUNA |
First Name Of The Provider |
SARA |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1100 S. FORT HARRISON |
Street Address 2 Of The Provider |
JSA FORT HARRISON PRIMARY CARE |
City Of The Provider |
CLEARWATER |
Zip Code Of The Provider |
337563908 |
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 |
30 |
Number Of Services |
735 |
Number Of Medicare Beneficiaries |
125 |
Total Submitted Charge Amount |
41480 |
Total Medicare Allowed Amount |
27302.94 |
Total Medicare Payment Amount |
18523.38 |
Total Medicare Standardized Payment Amount |
18647.5 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
84 |
Number Of Medicare Beneficiaries With Drug Services |
37 |
Total Drug Submitted ChargeAmount |
970 |
Total Drug Medicare AllowedAmount |
635.61 |
Total Drug Medicare PaymentAmount |
600.68 |
Total Drug Medicare Standardized Payment Amount |
600.68 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
22 |
Number Of Medical Services |
651 |
Number Of Medicare Beneficiaries With Medical Services |
125 |
Total Medical Submitted Charge Amount |
40510 |
Total Medical Medicare Allowed Amount |
26667.33 |
Total Medical Medicare Payment Amount |
17922.7 |
Total Medical Medicare Standardized Payment Amount |
18046.82 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
37 |
Number Of Beneficiaries Age 65 to 74 |
39 |
Number Of Beneficiaries Age 75 to 84 |
27 |
Number Of Beneficiaries Age Greater 84 |
22 |
Number Of Female Beneficiaries |
83 |
Number Of Male Beneficiaries |
42 |
Number Of Non Hispanic White Beneficiaries |
94 |
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 |
74 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
51 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
25 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
43 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.6027 |