National Provider Identifier [NPI]: |
1336121235 |
Last Name Of The Provider |
RIEWE |
First Name Of The Provider |
GLEN |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7117 BROCKTON AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
RIVERSIDE |
Zip Code Of The Provider |
925062615 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
27 |
Number Of Services |
499 |
Number Of Medicare Beneficiaries |
130 |
Total Submitted Charge Amount |
58195 |
Total Medicare Allowed Amount |
34831.75 |
Total Medicare Payment Amount |
24596.89 |
Total Medicare Standardized Payment Amount |
23636.87 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
33 |
Number Of Medicare Beneficiaries With Drug Services |
30 |
Total Drug Submitted ChargeAmount |
1449 |
Total Drug Medicare AllowedAmount |
677.33 |
Total Drug Medicare PaymentAmount |
662.47 |
Total Drug Medicare Standardized Payment Amount |
662.47 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
21 |
Number Of Medical Services |
466 |
Number Of Medicare Beneficiaries With Medical Services |
130 |
Total Medical Submitted Charge Amount |
56746 |
Total Medical Medicare Allowed Amount |
34154.42 |
Total Medical Medicare Payment Amount |
23934.42 |
Total Medical Medicare Standardized Payment Amount |
22974.4 |
Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
57 |
Number Of Beneficiaries Age 75 to 84 |
31 |
Number Of Beneficiaries Age Greater 84 |
25 |
Number Of Female Beneficiaries |
67 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
102 |
Number Of Black or African American Beneficiaries |
12 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
119 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
|
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
32 |
Percent Of With Chronic Obstructive Pulmonary Disease |
13 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
24 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2419 |