National Provider Identifier [NPI]: |
1366470247 |
Last Name Of The Provider |
HORNELL |
First Name Of The Provider |
ALLEN |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
804 SANTA FE DR |
Street Address 2 Of The Provider |
SUITE 102 |
City Of The Provider |
WEATHERFORD |
Zip Code Of The Provider |
760866525 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
55 |
Number Of Services |
1554 |
Number Of Medicare Beneficiaries |
212 |
Total Submitted Charge Amount |
124961.72 |
Total Medicare Allowed Amount |
74744.96 |
Total Medicare Payment Amount |
55145.56 |
Total Medicare Standardized Payment Amount |
58776.29 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
16 |
Number Of Drug Services |
279 |
Number Of Medicare Beneficiaries With Drug Services |
116 |
Total Drug Submitted ChargeAmount |
6208.8 |
Total Drug Medicare AllowedAmount |
4379.18 |
Total Drug Medicare PaymentAmount |
4227.56 |
Total Drug Medicare Standardized Payment Amount |
4227.56 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
1275 |
Number Of Medicare Beneficiaries With Medical Services |
212 |
Total Medical Submitted Charge Amount |
118752.92 |
Total Medical Medicare Allowed Amount |
70365.78 |
Total Medical Medicare Payment Amount |
50918 |
Total Medical Medicare Standardized Payment Amount |
54548.73 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
143 |
Number Of Beneficiaries Age 75 to 84 |
41 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
118 |
Number Of Male Beneficiaries |
94 |
Number Of Non Hispanic White Beneficiaries |
201 |
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
0 |
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 |
201 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
5 |
Percent Of With Asthma |
|
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9034 |