National Provider Identifier [NPI]: |
1447280680 |
Last Name Of The Provider |
SANTOS |
First Name Of The Provider |
ANGELITO |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
548 S MARINE CORPS DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
TAMUNING |
Zip Code Of The Provider |
969133539 |
State Code Of The Provider |
GU |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
316 |
Number Of Medicare Beneficiaries |
260 |
Total Submitted Charge Amount |
139011.4 |
Total Medicare Allowed Amount |
37019.28 |
Total Medicare Payment Amount |
26866.9 |
Total Medicare Standardized Payment Amount |
26667.72 |
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 |
15 |
Number Of Medical Services |
316 |
Number Of Medicare Beneficiaries With Medical Services |
260 |
Total Medical Submitted Charge Amount |
139011.4 |
Total Medical Medicare Allowed Amount |
37019.28 |
Total Medical Medicare Payment Amount |
26866.9 |
Total Medical Medicare Standardized Payment Amount |
26667.72 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
77 |
Number Of Beneficiaries Age 65 to 74 |
73 |
Number Of Beneficiaries Age 75 to 84 |
79 |
Number Of Beneficiaries Age Greater 84 |
31 |
Number Of Female Beneficiaries |
142 |
Number Of Male Beneficiaries |
118 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
127 |
Number Of Hispanic Beneficiaries |
83 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
32 |
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
11 |
Percent Of With Cancer |
7 |
Percent Of With Heart Failure |
49 |
Percent Of With Chronic Kidney Disease |
54 |
Percent Of With Chronic Obstructive Pulmonary Disease |
17 |
Percent Of With Depression |
5 |
Percent Of With Diabetes |
67 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
49 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
15 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.5112 |