National Provider Identifier [NPI]: |
1376654632 |
Last Name Of The Provider |
ANTHONY |
First Name Of The Provider |
JEFFREY |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6699 ALVARADO RD |
Street Address 2 Of The Provider |
SUITE 2100 |
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921205238 |
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 |
53 |
Number Of Services |
436 |
Number Of Medicare Beneficiaries |
114 |
Total Submitted Charge Amount |
35324 |
Total Medicare Allowed Amount |
27773.05 |
Total Medicare Payment Amount |
20463.47 |
Total Medicare Standardized Payment Amount |
19647.42 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
32 |
Number Of Medicare Beneficiaries With Drug Services |
19 |
Total Drug Submitted ChargeAmount |
2744 |
Total Drug Medicare AllowedAmount |
1390.38 |
Total Drug Medicare PaymentAmount |
1160.01 |
Total Drug Medicare Standardized Payment Amount |
1160.01 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
47 |
Number Of Medical Services |
404 |
Number Of Medicare Beneficiaries With Medical Services |
114 |
Total Medical Submitted Charge Amount |
32580 |
Total Medical Medicare Allowed Amount |
26382.67 |
Total Medical Medicare Payment Amount |
19303.46 |
Total Medical Medicare Standardized Payment Amount |
18487.41 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
79 |
Number Of Beneficiaries Age 75 to 84 |
23 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
48 |
Number Of Male Beneficiaries |
66 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
11 |
Percent Of With Diabetes |
18 |
Percent Of With Hyperlipidemia |
45 |
Percent Of With Hypertension |
46 |
Percent Of With Ischemic Heart Disease |
17 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7153 |