National Provider Identifier [NPI]: |
1982620811 |
Last Name Of The Provider |
MERCADO |
First Name Of The Provider |
ADA |
Middle Initial Of The Provider |
I |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
687 MARIETTA HWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
CANTON |
Zip Code Of The Provider |
301142608 |
State Code Of The Provider |
GA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
22 |
Number Of Services |
1385 |
Number Of Medicare Beneficiaries |
342 |
Total Submitted Charge Amount |
196591 |
Total Medicare Allowed Amount |
92744.11 |
Total Medicare Payment Amount |
67405.45 |
Total Medicare Standardized Payment Amount |
68280.2 |
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 |
22 |
Number Of Medical Services |
1385 |
Number Of Medicare Beneficiaries With Medical Services |
342 |
Total Medical Submitted Charge Amount |
196591 |
Total Medical Medicare Allowed Amount |
92744.11 |
Total Medical Medicare Payment Amount |
67405.45 |
Total Medical Medicare Standardized Payment Amount |
68280.2 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
156 |
Number Of Beneficiaries Age 75 to 84 |
96 |
Number Of Beneficiaries Age Greater 84 |
49 |
Number Of Female Beneficiaries |
233 |
Number Of Male Beneficiaries |
109 |
Number Of Non Hispanic White Beneficiaries |
296 |
Number Of Black or African American Beneficiaries |
21 |
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 |
275 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
67 |
Percent Of With Atrial Fibrillation |
30 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
28 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
1.5043 |