National Provider Identifier [NPI]: |
1033187125 |
Last Name Of The Provider |
GAMBIRAZIO |
First Name Of The Provider |
CARLOS |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
152 SAGAMORE PKWY W |
Street Address 2 Of The Provider |
|
City Of The Provider |
WEST LAFAYETTE |
Zip Code Of The Provider |
479061569 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
35 |
Number Of Services |
2431 |
Number Of Medicare Beneficiaries |
521 |
Total Submitted Charge Amount |
245128 |
Total Medicare Allowed Amount |
151431.01 |
Total Medicare Payment Amount |
112054.55 |
Total Medicare Standardized Payment Amount |
120260.95 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
254 |
Number Of Medicare Beneficiaries With Drug Services |
157 |
Total Drug Submitted ChargeAmount |
10586 |
Total Drug Medicare AllowedAmount |
4822.41 |
Total Drug Medicare PaymentAmount |
4502.17 |
Total Drug Medicare Standardized Payment Amount |
4502.17 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
30 |
Number Of Medical Services |
2177 |
Number Of Medicare Beneficiaries With Medical Services |
521 |
Total Medical Submitted Charge Amount |
234542 |
Total Medical Medicare Allowed Amount |
146608.6 |
Total Medical Medicare Payment Amount |
107552.38 |
Total Medical Medicare Standardized Payment Amount |
115758.78 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
35 |
Number Of Beneficiaries Age 65 to 74 |
278 |
Number Of Beneficiaries Age 75 to 84 |
161 |
Number Of Beneficiaries Age Greater 84 |
47 |
Number Of Female Beneficiaries |
282 |
Number Of Male Beneficiaries |
239 |
Number Of Non Hispanic White Beneficiaries |
485 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
16 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
495 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
26 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
13 |
Percent Of With Asthma |
5 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.0005 |