National Provider Identifier [NPI]: |
1558386763 |
Last Name Of The Provider |
MIJARES |
First Name Of The Provider |
CARLOS |
Middle Initial Of The Provider |
J |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1001 12TH AVE STE 160 |
Street Address 2 Of The Provider |
|
City Of The Provider |
FORT WORTH |
Zip Code Of The Provider |
761043926 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
33 |
Number Of Services |
2057 |
Number Of Medicare Beneficiaries |
305 |
Total Submitted Charge Amount |
260575.5 |
Total Medicare Allowed Amount |
128676.22 |
Total Medicare Payment Amount |
88137.2 |
Total Medicare Standardized Payment Amount |
90602.09 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
223 |
Number Of Medicare Beneficiaries With Drug Services |
123 |
Total Drug Submitted ChargeAmount |
8968.5 |
Total Drug Medicare AllowedAmount |
3914.11 |
Total Drug Medicare PaymentAmount |
3792.32 |
Total Drug Medicare Standardized Payment Amount |
3792.32 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
1834 |
Number Of Medicare Beneficiaries With Medical Services |
305 |
Total Medical Submitted Charge Amount |
251607 |
Total Medical Medicare Allowed Amount |
124762.11 |
Total Medical Medicare Payment Amount |
84344.88 |
Total Medical Medicare Standardized Payment Amount |
86809.77 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
148 |
Number Of Beneficiaries Age 75 to 84 |
107 |
Number Of Beneficiaries Age Greater 84 |
27 |
Number Of Female Beneficiaries |
165 |
Number Of Male Beneficiaries |
140 |
Number Of Non Hispanic White Beneficiaries |
168 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
91 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
257 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
48 |
Percent Of With Atrial Fibrillation |
5 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
22 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
42 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1072 |