National Provider Identifier [NPI]: |
1538239173 |
Last Name Of The Provider |
DAY |
First Name Of The Provider |
GUSTAVO |
Middle Initial Of The Provider |
H |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7777 FOREST LN |
Street Address 2 Of The Provider |
BUILDING B, SUITE416 |
City Of The Provider |
DALLAS |
Zip Code Of The Provider |
752302505 |
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 |
73 |
Number Of Services |
6895 |
Number Of Medicare Beneficiaries |
420 |
Total Submitted Charge Amount |
375831.35 |
Total Medicare Allowed Amount |
248502.4 |
Total Medicare Payment Amount |
188630.67 |
Total Medicare Standardized Payment Amount |
183001.77 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
13 |
Number Of Drug Services |
2503 |
Number Of Medicare Beneficiaries With Drug Services |
225 |
Total Drug Submitted ChargeAmount |
43838.18 |
Total Drug Medicare AllowedAmount |
16069.61 |
Total Drug Medicare PaymentAmount |
13838.75 |
Total Drug Medicare Standardized Payment Amount |
13838.75 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
60 |
Number Of Medical Services |
4392 |
Number Of Medicare Beneficiaries With Medical Services |
420 |
Total Medical Submitted Charge Amount |
331993.17 |
Total Medical Medicare Allowed Amount |
232432.79 |
Total Medical Medicare Payment Amount |
174791.92 |
Total Medical Medicare Standardized Payment Amount |
169163.02 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
72 |
Number Of Beneficiaries Age 65 to 74 |
189 |
Number Of Beneficiaries Age 75 to 84 |
106 |
Number Of Beneficiaries Age Greater 84 |
53 |
Number Of Female Beneficiaries |
268 |
Number Of Male Beneficiaries |
152 |
Number Of Non Hispanic White Beneficiaries |
215 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
121 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
323 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
97 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
18 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
15 |
Percent Of With Depression |
21 |
Percent Of With Diabetes |
34 |
Percent Of With Hyperlipidemia |
46 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
10 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
39 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
3 |
Average HCC Risk Score Of Beneficiaries |
1.3602 |