National Provider Identifier [NPI]: |
1174637771 |
Last Name Of The Provider |
PEREZ |
First Name Of The Provider |
CHRISTINE |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1321 COLBY AVE |
Street Address 2 Of The Provider |
MEDICAL STAFF OFFICE |
City Of The Provider |
EVERETT |
Zip Code Of The Provider |
982011665 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
269 |
Number Of Medicare Beneficiaries |
253 |
Total Submitted Charge Amount |
118069 |
Total Medicare Allowed Amount |
52208.52 |
Total Medicare Payment Amount |
39768.66 |
Total Medicare Standardized Payment Amount |
40618.33 |
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 |
11 |
Number Of Medical Services |
269 |
Number Of Medicare Beneficiaries With Medical Services |
253 |
Total Medical Submitted Charge Amount |
118069 |
Total Medical Medicare Allowed Amount |
52208.52 |
Total Medical Medicare Payment Amount |
39768.66 |
Total Medical Medicare Standardized Payment Amount |
40618.33 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
72 |
Number Of Beneficiaries Age 65 to 74 |
69 |
Number Of Beneficiaries Age 75 to 84 |
62 |
Number Of Beneficiaries Age Greater 84 |
50 |
Number Of Female Beneficiaries |
143 |
Number Of Male Beneficiaries |
110 |
Number Of Non Hispanic White Beneficiaries |
221 |
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 |
142 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
111 |
Percent Of With Atrial Fibrillation |
23 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
38 |
Percent Of With Chronic Kidney Disease |
58 |
Percent Of With Chronic Obstructive Pulmonary Disease |
35 |
Percent Of With Depression |
46 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
57 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
38 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.3103 |