National Provider Identifier [NPI]: |
1679579700 |
Last Name Of The Provider |
ENGLISH |
First Name Of The Provider |
WILLIAM |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
111 DALLAS ST |
Street Address 2 Of The Provider |
STE 200-A |
City Of The Provider |
SAN ANTONIO |
Zip Code Of The Provider |
782051201 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Vascular Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
112 |
Number Of Services |
4076 |
Number Of Medicare Beneficiaries |
544 |
Total Submitted Charge Amount |
19498307 |
Total Medicare Allowed Amount |
5180530.54 |
Total Medicare Payment Amount |
3962614.75 |
Total Medicare Standardized Payment Amount |
4416874.27 |
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 |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
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 |
184 |
Number Of Beneficiaries Age 65 to 74 |
172 |
Number Of Beneficiaries Age 75 to 84 |
138 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
248 |
Number Of Male Beneficiaries |
296 |
Number Of Non Hispanic White Beneficiaries |
133 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
348 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
240 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
304 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
4 |
Percent Of With Heart Failure |
56 |
Percent Of With Chronic Kidney Disease |
75 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
75 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
5.4517 |