National Provider Identifier [NPI]: |
1437189966 |
Last Name Of The Provider |
HO |
First Name Of The Provider |
GUSTIN |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
929 CLAY ST |
Street Address 2 Of The Provider |
#401 |
City Of The Provider |
SAN FRANCISCO |
Zip Code Of The Provider |
941081556 |
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 |
46 |
Number Of Services |
7887 |
Number Of Medicare Beneficiaries |
843 |
Total Submitted Charge Amount |
762810 |
Total Medicare Allowed Amount |
489670.49 |
Total Medicare Payment Amount |
369789.42 |
Total Medicare Standardized Payment Amount |
308677.72 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
1639 |
Number Of Medicare Beneficiaries With Drug Services |
489 |
Total Drug Submitted ChargeAmount |
29910 |
Total Drug Medicare AllowedAmount |
13308.38 |
Total Drug Medicare PaymentAmount |
12595.49 |
Total Drug Medicare Standardized Payment Amount |
12595.49 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
6248 |
Number Of Medicare Beneficiaries With Medical Services |
843 |
Total Medical Submitted Charge Amount |
732900 |
Total Medical Medicare Allowed Amount |
476362.11 |
Total Medical Medicare Payment Amount |
357193.93 |
Total Medical Medicare Standardized Payment Amount |
296082.23 |
Average Age Of Beneficiaries |
79 |
Number Of Beneficiaries Age Less65 |
26 |
Number Of Beneficiaries Age 65 to 74 |
227 |
Number Of Beneficiaries Age 75 to 84 |
377 |
Number Of Beneficiaries Age Greater 84 |
213 |
Number Of Female Beneficiaries |
533 |
Number Of Male Beneficiaries |
310 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
818 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
12 |
Number Of Beneficiaries With Medicare Only Entitlement |
58 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
785 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
12 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
8 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
61 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
21 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
60 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.1309 |