National Provider Identifier [NPI]: |
1063578607 |
Last Name Of The Provider |
GONZALES-NATE |
First Name Of The Provider |
CARMEN |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11660 EMERALD DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
LOMA LINDA |
Zip Code Of The Provider |
923544140 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
8 |
Number Of Services |
841 |
Number Of Medicare Beneficiaries |
143 |
Total Submitted Charge Amount |
96220 |
Total Medicare Allowed Amount |
73702.34 |
Total Medicare Payment Amount |
57507.76 |
Total Medicare Standardized Payment Amount |
56639.46 |
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 |
8 |
Number Of Medical Services |
841 |
Number Of Medicare Beneficiaries With Medical Services |
143 |
Total Medical Submitted Charge Amount |
96220 |
Total Medical Medicare Allowed Amount |
73702.34 |
Total Medical Medicare Payment Amount |
57507.76 |
Total Medical Medicare Standardized Payment Amount |
56639.46 |
Average Age Of Beneficiaries |
63 |
Number Of Beneficiaries Age Less65 |
67 |
Number Of Beneficiaries Age 65 to 74 |
47 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
64 |
Number Of Male Beneficiaries |
79 |
Number Of Non Hispanic White Beneficiaries |
67 |
Number Of Black or African American Beneficiaries |
28 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
33 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
31 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
20 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
44 |
Percent Of With Depression |
47 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
39 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
75 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.2462 |