National Provider Identifier [NPI]: |
1164626875 |
Last Name Of The Provider |
DEMBLA |
First Name Of The Provider |
GEETIKA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1501 KINGS HWY |
Street Address 2 Of The Provider |
|
City Of The Provider |
SHREVEPORT |
Zip Code Of The Provider |
711034228 |
State Code Of The Provider |
LA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
826 |
Number Of Medicare Beneficiaries |
154 |
Total Submitted Charge Amount |
105145 |
Total Medicare Allowed Amount |
61934.07 |
Total Medicare Payment Amount |
47095.61 |
Total Medicare Standardized Payment Amount |
48777.77 |
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 |
15 |
Number Of Medical Services |
826 |
Number Of Medicare Beneficiaries With Medical Services |
154 |
Total Medical Submitted Charge Amount |
105145 |
Total Medical Medicare Allowed Amount |
61934.07 |
Total Medical Medicare Payment Amount |
47095.61 |
Total Medical Medicare Standardized Payment Amount |
48777.77 |
Average Age Of Beneficiaries |
51 |
Number Of Beneficiaries Age Less65 |
121 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
83 |
Number Of Male Beneficiaries |
71 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
95 |
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 |
40 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
114 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
8 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
18 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
53 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
33 |
Percent Of With Hypertension |
60 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
23 |
Percent Of With Schizophrenia Other PsychoticDisorders |
58 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2595 |