National Provider Identifier [NPI]: |
1851543862 |
Last Name Of The Provider |
VALENCIA |
First Name Of The Provider |
CARLO |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1021 GILPIN AVE |
Street Address 2 Of The Provider |
SUITE 203 |
City Of The Provider |
WILMINGTON |
Zip Code Of The Provider |
198063270 |
State Code Of The Provider |
DE |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
29 |
Number Of Services |
457 |
Number Of Medicare Beneficiaries |
102 |
Total Submitted Charge Amount |
54951 |
Total Medicare Allowed Amount |
41994.65 |
Total Medicare Payment Amount |
30895.66 |
Total Medicare Standardized Payment Amount |
30891.53 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
30 |
Number Of Medicare Beneficiaries With Drug Services |
23 |
Total Drug Submitted ChargeAmount |
1060 |
Total Drug Medicare AllowedAmount |
769.38 |
Total Drug Medicare PaymentAmount |
718.21 |
Total Drug Medicare Standardized Payment Amount |
718.21 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
427 |
Number Of Medicare Beneficiaries With Medical Services |
102 |
Total Medical Submitted Charge Amount |
53891 |
Total Medical Medicare Allowed Amount |
41225.27 |
Total Medical Medicare Payment Amount |
30177.45 |
Total Medical Medicare Standardized Payment Amount |
30173.32 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
30 |
Number Of Beneficiaries Age 65 to 74 |
42 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
40 |
Number Of Male Beneficiaries |
62 |
Number Of Non Hispanic White Beneficiaries |
55 |
Number Of Black or African American Beneficiaries |
|
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 |
67 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
35 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
38 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
25 |
Percent Of With Diabetes |
40 |
Percent Of With Hyperlipidemia |
68 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4685 |