National Provider Identifier [NPI]: |
1114959558 |
Last Name Of The Provider |
LU |
First Name Of The Provider |
WILLIE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
320 DARDANELLI LN |
Street Address 2 Of The Provider |
SUITE @ 21 B |
City Of The Provider |
LOS GATOS |
Zip Code Of The Provider |
950321440 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
16 |
Number Of Services |
2111 |
Number Of Medicare Beneficiaries |
400 |
Total Submitted Charge Amount |
194075.14 |
Total Medicare Allowed Amount |
168947.26 |
Total Medicare Payment Amount |
137128.67 |
Total Medicare Standardized Payment Amount |
121662.13 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
1 |
Number Of Drug Services |
20 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
667.4 |
Total Drug Medicare AllowedAmount |
667.4 |
Total Drug Medicare PaymentAmount |
654 |
Total Drug Medicare Standardized Payment Amount |
654 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
15 |
Number Of Medical Services |
2091 |
Number Of Medicare Beneficiaries With Medical Services |
400 |
Total Medical Submitted Charge Amount |
193407.74 |
Total Medical Medicare Allowed Amount |
168279.86 |
Total Medical Medicare Payment Amount |
136474.67 |
Total Medical Medicare Standardized Payment Amount |
121008.13 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
195 |
Number Of Beneficiaries Age 75 to 84 |
142 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
192 |
Number Of Male Beneficiaries |
208 |
Number Of Non Hispanic White Beneficiaries |
338 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
36 |
Number Of Hispanic Beneficiaries |
12 |
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 |
12 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
3 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
7 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
6 |
Percent Of With Depression |
8 |
Percent Of With Diabetes |
21 |
Percent Of With Hyperlipidemia |
74 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.8053 |