National Provider Identifier [NPI]: |
1215990635 |
Last Name Of The Provider |
WOLF |
First Name Of The Provider |
STEVEN |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3536 MENDOCINO AVE |
Street Address 2 Of The Provider |
STE 300 |
City Of The Provider |
SANTA ROSA |
Zip Code Of The Provider |
95403 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
54 |
Number Of Services |
551 |
Number Of Medicare Beneficiaries |
137 |
Total Submitted Charge Amount |
90663.6 |
Total Medicare Allowed Amount |
35839.68 |
Total Medicare Payment Amount |
24533.65 |
Total Medicare Standardized Payment Amount |
23891.16 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
10 |
Number Of Drug Services |
141 |
Number Of Medicare Beneficiaries With Drug Services |
55 |
Total Drug Submitted ChargeAmount |
5167 |
Total Drug Medicare AllowedAmount |
3047.33 |
Total Drug Medicare PaymentAmount |
2932.35 |
Total Drug Medicare Standardized Payment Amount |
2932.35 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
44 |
Number Of Medical Services |
410 |
Number Of Medicare Beneficiaries With Medical Services |
136 |
Total Medical Submitted Charge Amount |
85496.6 |
Total Medical Medicare Allowed Amount |
32792.35 |
Total Medical Medicare Payment Amount |
21601.3 |
Total Medical Medicare Standardized Payment Amount |
20958.81 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
84 |
Number Of Beneficiaries Age 75 to 84 |
23 |
Number Of Beneficiaries Age Greater 84 |
13 |
Number Of Female Beneficiaries |
74 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
118 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
17 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
40 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9473 |