National Provider Identifier [NPI]: |
1699781831 |
Last Name Of The Provider |
D'AGOSTINO |
First Name Of The Provider |
DARRIN |
Middle Initial Of The Provider |
C |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
855 MONTGOMERY ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
FORT WORTH |
Zip Code Of The Provider |
761072553 |
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 |
31 |
Number Of Services |
243 |
Number Of Medicare Beneficiaries |
120 |
Total Submitted Charge Amount |
47309 |
Total Medicare Allowed Amount |
21604.24 |
Total Medicare Payment Amount |
16100.94 |
Total Medicare Standardized Payment Amount |
16609.39 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
|
Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
|
Total Drug Medicare AllowedAmount |
|
Total Drug Medicare PaymentAmount |
|
Total Drug Medicare Standardized Payment Amount |
|
Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
|
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
18 |
Number Of Beneficiaries Age 65 to 74 |
49 |
Number Of Beneficiaries Age 75 to 84 |
35 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
72 |
Number Of Male Beneficiaries |
48 |
Number Of Non Hispanic White Beneficiaries |
89 |
Number Of Black or African American Beneficiaries |
17 |
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 |
84 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
36 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
12 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
32 |
Percent Of With Chronic Kidney Disease |
46 |
Percent Of With Chronic Obstructive Pulmonary Disease |
38 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
66 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
41 |
Percent Of With Osteoporosis |
20 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
1.6 |