National Provider Identifier [NPI]: |
1629005400 |
Last Name Of The Provider |
WONG |
First Name Of The Provider |
KA |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1400 GEORGE DIETER DR |
Street Address 2 Of The Provider |
SUITE 130 |
City Of The Provider |
EL PASO |
Zip Code Of The Provider |
799367601 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
88 |
Number Of Services |
7307 |
Number Of Medicare Beneficiaries |
1241 |
Total Submitted Charge Amount |
779960 |
Total Medicare Allowed Amount |
598957.21 |
Total Medicare Payment Amount |
442354.24 |
Total Medicare Standardized Payment Amount |
470466.7 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
88 |
Number Of Medical Services |
7307 |
Number Of Medicare Beneficiaries With Medical Services |
1241 |
Total Medical Submitted Charge Amount |
779960 |
Total Medical Medicare Allowed Amount |
598957.21 |
Total Medical Medicare Payment Amount |
442354.24 |
Total Medical Medicare Standardized Payment Amount |
470466.7 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
145 |
Number Of Beneficiaries Age 65 to 74 |
363 |
Number Of Beneficiaries Age 75 to 84 |
438 |
Number Of Beneficiaries Age Greater 84 |
295 |
Number Of Female Beneficiaries |
743 |
Number Of Male Beneficiaries |
498 |
Number Of Non Hispanic White Beneficiaries |
376 |
Number Of Black or African American Beneficiaries |
47 |
Number Of AsianPacific Islander Beneficiaries |
11 |
Number Of Hispanic Beneficiaries |
792 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
750 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
491 |
Percent Of With Atrial Fibrillation |
17 |
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
67 |
Percent Of With Chronic Kidney Disease |
42 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
55 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.1186 |