National Provider Identifier [NPI]: |
1356441356 |
Last Name Of The Provider |
MINOR |
First Name Of The Provider |
DAVID |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7725 N 43RD AVE |
Street Address 2 Of The Provider |
STE 720 |
City Of The Provider |
PHOENIX |
Zip Code Of The Provider |
850515770 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
40 |
Number Of Services |
475 |
Number Of Medicare Beneficiaries |
121 |
Total Submitted Charge Amount |
54808 |
Total Medicare Allowed Amount |
35941.26 |
Total Medicare Payment Amount |
23297.93 |
Total Medicare Standardized Payment Amount |
24360.24 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
65 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
1561 |
Total Drug Medicare AllowedAmount |
656.88 |
Total Drug Medicare PaymentAmount |
613.33 |
Total Drug Medicare Standardized Payment Amount |
613.33 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
33 |
Number Of Medical Services |
410 |
Number Of Medicare Beneficiaries With Medical Services |
121 |
Total Medical Submitted Charge Amount |
53247 |
Total Medical Medicare Allowed Amount |
35284.38 |
Total Medical Medicare Payment Amount |
22684.6 |
Total Medical Medicare Standardized Payment Amount |
23746.91 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
27 |
Number Of Beneficiaries Age 65 to 74 |
47 |
Number Of Beneficiaries Age 75 to 84 |
35 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
58 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
102 |
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 |
95 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
26 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
20 |
Percent Of With Diabetes |
22 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
29 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1155 |