National Provider Identifier [NPI]: |
1740296151 |
Last Name Of The Provider |
NEWMAN |
First Name Of The Provider |
ALAN |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
D.D.S. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
444 S SAN VICENTE BLVD |
Street Address 2 Of The Provider |
#1101 |
City Of The Provider |
LOS ANGELES |
Zip Code Of The Provider |
900484165 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Oral Surgery (dentists only) |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
652 |
Number Of Medicare Beneficiaries |
175 |
Total Submitted Charge Amount |
246155 |
Total Medicare Allowed Amount |
76128.14 |
Total Medicare Payment Amount |
59190.72 |
Total Medicare Standardized Payment Amount |
55822.31 |
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 |
11 |
Number Of Medical Services |
652 |
Number Of Medicare Beneficiaries With Medical Services |
175 |
Total Medical Submitted Charge Amount |
246155 |
Total Medical Medicare Allowed Amount |
76128.14 |
Total Medical Medicare Payment Amount |
59190.72 |
Total Medical Medicare Standardized Payment Amount |
55822.31 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
32 |
Number Of Beneficiaries Age 65 to 74 |
72 |
Number Of Beneficiaries Age 75 to 84 |
52 |
Number Of Beneficiaries Age Greater 84 |
19 |
Number Of Female Beneficiaries |
111 |
Number Of Male Beneficiaries |
64 |
Number Of Non Hispanic White Beneficiaries |
143 |
Number Of Black or African American Beneficiaries |
13 |
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 |
136 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
39 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
65 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2191 |