National Provider Identifier [NPI]: |
1609006618 |
Last Name Of The Provider |
BOULATTOUF |
First Name Of The Provider |
DANI |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
8105 RITCHIE HWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
PASADENA |
Zip Code Of The Provider |
211223905 |
State Code Of The Provider |
MD |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
76 |
Number Of Services |
1196 |
Number Of Medicare Beneficiaries |
435 |
Total Submitted Charge Amount |
105468.36 |
Total Medicare Allowed Amount |
46760.97 |
Total Medicare Payment Amount |
34044.9 |
Total Medicare Standardized Payment Amount |
32001.07 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
105 |
Number Of Medicare Beneficiaries With Drug Services |
65 |
Total Drug Submitted ChargeAmount |
1513.36 |
Total Drug Medicare AllowedAmount |
660.64 |
Total Drug Medicare PaymentAmount |
600.61 |
Total Drug Medicare Standardized Payment Amount |
600.61 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
64 |
Number Of Medical Services |
1091 |
Number Of Medicare Beneficiaries With Medical Services |
433 |
Total Medical Submitted Charge Amount |
103955 |
Total Medical Medicare Allowed Amount |
46100.33 |
Total Medical Medicare Payment Amount |
33444.29 |
Total Medical Medicare Standardized Payment Amount |
31400.46 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
61 |
Number Of Beneficiaries Age 65 to 74 |
205 |
Number Of Beneficiaries Age 75 to 84 |
124 |
Number Of Beneficiaries Age Greater 84 |
45 |
Number Of Female Beneficiaries |
299 |
Number Of Male Beneficiaries |
136 |
Number Of Non Hispanic White Beneficiaries |
249 |
Number Of Black or African American Beneficiaries |
144 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
20 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
11 |
Number Of Beneficiaries With Medicare Only Entitlement |
383 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
52 |
Percent Of With Atrial Fibrillation |
8 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
9 |
Percent Of With Chronic Kidney Disease |
15 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
16 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
51 |
Percent Of With Hypertension |
62 |
Percent Of With Ischemic Heart Disease |
23 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
0.9551 |