National Provider Identifier [NPI]: |
1659661148 |
Last Name Of The Provider |
TSO |
First Name Of The Provider |
CHI |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
P.T. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
490 W EL CAMINO REAL |
Street Address 2 Of The Provider |
|
City Of The Provider |
MOUNTAIN VIEW |
Zip Code Of The Provider |
940402610 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physical Therapist |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
12 |
Number Of Services |
6832 |
Number Of Medicare Beneficiaries |
261 |
Total Submitted Charge Amount |
592517 |
Total Medicare Allowed Amount |
193244.16 |
Total Medicare Payment Amount |
149437.54 |
Total Medicare Standardized Payment Amount |
99380.4 |
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 |
12 |
Number Of Medical Services |
6832 |
Number Of Medicare Beneficiaries With Medical Services |
261 |
Total Medical Submitted Charge Amount |
592517 |
Total Medical Medicare Allowed Amount |
193244.16 |
Total Medical Medicare Payment Amount |
149437.54 |
Total Medical Medicare Standardized Payment Amount |
99380.4 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
117 |
Number Of Beneficiaries Age 75 to 84 |
99 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
177 |
Number Of Male Beneficiaries |
84 |
Number Of Non Hispanic White Beneficiaries |
200 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
26 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
244 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
17 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
13 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
36 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.0791 |