National Provider Identifier [NPI]: |
1669524021 |
Last Name Of The Provider |
OH |
First Name Of The Provider |
BISMARK |
Middle Initial Of The Provider |
Y |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4002 VISTA WAY |
Street Address 2 Of The Provider |
EMERGENCY DEPARTMENT |
City Of The Provider |
OCEANSIDE |
Zip Code Of The Provider |
920564506 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
923 |
Number Of Medicare Beneficiaries |
510 |
Total Submitted Charge Amount |
271508 |
Total Medicare Allowed Amount |
89542.42 |
Total Medicare Payment Amount |
69594.45 |
Total Medicare Standardized Payment Amount |
68794.94 |
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 |
35 |
Number Of Medical Services |
923 |
Number Of Medicare Beneficiaries With Medical Services |
510 |
Total Medical Submitted Charge Amount |
271508 |
Total Medical Medicare Allowed Amount |
89542.42 |
Total Medical Medicare Payment Amount |
69594.45 |
Total Medical Medicare Standardized Payment Amount |
68794.94 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
121 |
Number Of Beneficiaries Age 65 to 74 |
114 |
Number Of Beneficiaries Age 75 to 84 |
129 |
Number Of Beneficiaries Age Greater 84 |
146 |
Number Of Female Beneficiaries |
299 |
Number Of Male Beneficiaries |
211 |
Number Of Non Hispanic White Beneficiaries |
376 |
Number Of Black or African American Beneficiaries |
29 |
Number Of AsianPacific Islander Beneficiaries |
21 |
Number Of Hispanic Beneficiaries |
67 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
327 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
183 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
29 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
37 |
Percent Of With Chronic Kidney Disease |
43 |
Percent Of With Chronic Obstructive Pulmonary Disease |
27 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
52 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
16 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.2927 |