National Provider Identifier [NPI]: |
1023103264 |
Last Name Of The Provider |
GUTIERREZ |
First Name Of The Provider |
SYLVIA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6707 N 19TH AVE 104 |
Street Address 2 Of The Provider |
|
City Of The Provider |
PHOENIX |
Zip Code Of The Provider |
85015 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
14 |
Number Of Services |
271 |
Number Of Medicare Beneficiaries |
75 |
Total Submitted Charge Amount |
26034.31 |
Total Medicare Allowed Amount |
19174.93 |
Total Medicare Payment Amount |
11924.33 |
Total Medicare Standardized Payment Amount |
12892.52 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
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Number Of Drug Services |
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Number Of Medicare Beneficiaries With Drug Services |
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Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
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Number Of Medical Services |
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Number Of Medicare Beneficiaries With Medical Services |
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Total Medical Submitted Charge Amount |
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Total Medical Medicare Allowed Amount |
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Total Medical Medicare Payment Amount |
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Total Medical Medicare Standardized Payment Amount |
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Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
43 |
Number Of Beneficiaries Age 75 to 84 |
17 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
46 |
Number Of Male Beneficiaries |
29 |
Number Of Non Hispanic White Beneficiaries |
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Number Of Black or African American Beneficiaries |
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Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
44 |
Number Of American Indian Alaska Native Beneficiaries |
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Number Of Beneficiaries With Race Not Else where Classified |
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Number Of Beneficiaries With Medicare Only Entitlement |
63 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
12 |
Percent Of With Atrial Fibrillation |
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Percent Of With Alzheimers Disease or Dementia |
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Percent Of With Asthma |
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Percent Of With Cancer |
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Percent Of With Heart Failure |
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Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
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Percent Of With Depression |
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Percent Of With Diabetes |
48 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
68 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
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Percent Of With Rheumatoid Arthritis Osteoarthritis |
24 |
Percent Of With Schizophrenia Other PsychoticDisorders |
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Percent Of With Stroke |
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Average HCC Risk Score Of Beneficiaries |
1.0773 |