National Provider Identifier [NPI]: |
1871518977 |
Last Name Of The Provider |
CALLISTER |
First Name Of The Provider |
CYRIL |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
PA-C |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
350 30TH ST |
Street Address 2 Of The Provider |
SUITE 100 |
City Of The Provider |
OAKLAND |
Zip Code Of The Provider |
946093424 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
24 |
Number Of Services |
493 |
Number Of Medicare Beneficiaries |
242 |
Total Submitted Charge Amount |
108150 |
Total Medicare Allowed Amount |
33552.14 |
Total Medicare Payment Amount |
22089.9 |
Total Medicare Standardized Payment Amount |
22856.55 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
30 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
2278 |
Total Drug Medicare AllowedAmount |
969.48 |
Total Drug Medicare PaymentAmount |
950.03 |
Total Drug Medicare Standardized Payment Amount |
950.03 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
463 |
Number Of Medicare Beneficiaries With Medical Services |
242 |
Total Medical Submitted Charge Amount |
105872 |
Total Medical Medicare Allowed Amount |
32582.66 |
Total Medical Medicare Payment Amount |
21139.87 |
Total Medical Medicare Standardized Payment Amount |
21906.52 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
57 |
Number Of Beneficiaries Age 65 to 74 |
107 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
28 |
Number Of Female Beneficiaries |
159 |
Number Of Male Beneficiaries |
83 |
Number Of Non Hispanic White Beneficiaries |
74 |
Number Of Black or African American Beneficiaries |
133 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
18 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
156 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
86 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
38 |
Percent Of With Hypertension |
55 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1022 |