National Provider Identifier [NPI]: |
1023048816 |
Last Name Of The Provider |
HAGGLOV |
First Name Of The Provider |
CALVIN |
Middle Initial Of The Provider |
G |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
25455 BARTON RD |
Street Address 2 Of The Provider |
SUITE 204B |
City Of The Provider |
LOMA LINDA |
Zip Code Of The Provider |
923543128 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
43 |
Number Of Services |
1239 |
Number Of Medicare Beneficiaries |
357 |
Total Submitted Charge Amount |
243530 |
Total Medicare Allowed Amount |
85087.52 |
Total Medicare Payment Amount |
60280.33 |
Total Medicare Standardized Payment Amount |
58455.89 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
190 |
Number Of Medicare Beneficiaries With Drug Services |
100 |
Total Drug Submitted ChargeAmount |
9190 |
Total Drug Medicare AllowedAmount |
2581.87 |
Total Drug Medicare PaymentAmount |
2503.69 |
Total Drug Medicare Standardized Payment Amount |
2503.69 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
32 |
Number Of Medical Services |
1049 |
Number Of Medicare Beneficiaries With Medical Services |
356 |
Total Medical Submitted Charge Amount |
234340 |
Total Medical Medicare Allowed Amount |
82505.65 |
Total Medical Medicare Payment Amount |
57776.64 |
Total Medical Medicare Standardized Payment Amount |
55952.2 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
86 |
Number Of Beneficiaries Age 65 to 74 |
137 |
Number Of Beneficiaries Age 75 to 84 |
99 |
Number Of Beneficiaries Age Greater 84 |
35 |
Number Of Female Beneficiaries |
187 |
Number Of Male Beneficiaries |
170 |
Number Of Non Hispanic White Beneficiaries |
206 |
Number Of Black or African American Beneficiaries |
38 |
Number Of AsianPacific Islander Beneficiaries |
21 |
Number Of Hispanic Beneficiaries |
80 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
235 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
122 |
Percent Of With Atrial Fibrillation |
13 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
27 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
31 |
Percent Of With Hyperlipidemia |
38 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.3166 |