National Provider Identifier [NPI]: |
1821178716 |
Last Name Of The Provider |
COLBY |
First Name Of The Provider |
SARA |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2400 SAMARITAN DR STE 203 |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN JOSE |
Zip Code Of The Provider |
951243910 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Dermatology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
65 |
Number Of Services |
5952 |
Number Of Medicare Beneficiaries |
888 |
Total Submitted Charge Amount |
590271 |
Total Medicare Allowed Amount |
357592.6 |
Total Medicare Payment Amount |
252304.72 |
Total Medicare Standardized Payment Amount |
208916.59 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
50 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
472 |
Total Drug Medicare AllowedAmount |
336.52 |
Total Drug Medicare PaymentAmount |
147.17 |
Total Drug Medicare Standardized Payment Amount |
147.17 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
63 |
Number Of Medical Services |
5902 |
Number Of Medicare Beneficiaries With Medical Services |
888 |
Total Medical Submitted Charge Amount |
589799 |
Total Medical Medicare Allowed Amount |
357256.08 |
Total Medical Medicare Payment Amount |
252157.55 |
Total Medical Medicare Standardized Payment Amount |
208769.42 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
21 |
Number Of Beneficiaries Age 65 to 74 |
479 |
Number Of Beneficiaries Age 75 to 84 |
292 |
Number Of Beneficiaries Age Greater 84 |
96 |
Number Of Female Beneficiaries |
614 |
Number Of Male Beneficiaries |
274 |
Number Of Non Hispanic White Beneficiaries |
838 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
18 |
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
8 |
Percent Of With Chronic Kidney Disease |
11 |
Percent Of With Chronic Obstructive Pulmonary Disease |
5 |
Percent Of With Depression |
9 |
Percent Of With Diabetes |
19 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
52 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
37 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.8022 |