National Provider Identifier [NPI]: |
1538375365 |
Last Name Of The Provider |
FORREST |
First Name Of The Provider |
BRENDA |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
M.D |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
900 GREENLEY RD |
Street Address 2 Of The Provider |
SUITE 922 |
City Of The Provider |
SONORA |
Zip Code Of The Provider |
95370 |
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 |
17 |
Number Of Services |
1376 |
Number Of Medicare Beneficiaries |
413 |
Total Submitted Charge Amount |
109964 |
Total Medicare Allowed Amount |
77174.19 |
Total Medicare Payment Amount |
53668.52 |
Total Medicare Standardized Payment Amount |
53822.87 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
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 |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
181 |
Number Of Beneficiaries Age 75 to 84 |
144 |
Number Of Beneficiaries Age Greater 84 |
62 |
Number Of Female Beneficiaries |
305 |
Number Of Male Beneficiaries |
108 |
Number Of Non Hispanic White Beneficiaries |
383 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
17 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
379 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
34 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
13 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.0506 |