National Provider Identifier [NPI]: |
1639361033 |
Last Name Of The Provider |
FUENTES |
First Name Of The Provider |
CARMEN |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
6161 KEMPSVILLE CIR |
Street Address 2 Of The Provider |
SUITE 315 |
City Of The Provider |
NORFOLK |
Zip Code Of The Provider |
235023932 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Neurology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
28 |
Number Of Services |
8588 |
Number Of Medicare Beneficiaries |
510 |
Total Submitted Charge Amount |
385356 |
Total Medicare Allowed Amount |
219367.1 |
Total Medicare Payment Amount |
158146.48 |
Total Medicare Standardized Payment Amount |
162482.96 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
7247 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
75325 |
Total Drug Medicare AllowedAmount |
43131.77 |
Total Drug Medicare PaymentAmount |
31942.85 |
Total Drug Medicare Standardized Payment Amount |
31942.85 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
25 |
Number Of Medical Services |
1341 |
Number Of Medicare Beneficiaries With Medical Services |
510 |
Total Medical Submitted Charge Amount |
310031 |
Total Medical Medicare Allowed Amount |
176235.33 |
Total Medical Medicare Payment Amount |
126203.63 |
Total Medical Medicare Standardized Payment Amount |
130540.11 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
65 |
Number Of Beneficiaries Age 65 to 74 |
201 |
Number Of Beneficiaries Age 75 to 84 |
181 |
Number Of Beneficiaries Age Greater 84 |
63 |
Number Of Female Beneficiaries |
259 |
Number Of Male Beneficiaries |
251 |
Number Of Non Hispanic White Beneficiaries |
382 |
Number Of Black or African American Beneficiaries |
98 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
13 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
436 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
74 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
10 |
Percent Of With Heart Failure |
17 |
Percent Of With Chronic Kidney Disease |
21 |
Percent Of With Chronic Obstructive Pulmonary Disease |
16 |
Percent Of With Depression |
34 |
Percent Of With Diabetes |
33 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
33 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
44 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.477 |