National Provider Identifier [NPI]: |
1578501714 |
Last Name Of The Provider |
HO |
First Name Of The Provider |
HAREL |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
880 S ATLANTIC BLVD |
Street Address 2 Of The Provider |
#302 |
City Of The Provider |
MONTEREY PARK |
Zip Code Of The Provider |
917544700 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
10 |
Number Of Services |
260 |
Number Of Medicare Beneficiaries |
57 |
Total Submitted Charge Amount |
23118 |
Total Medicare Allowed Amount |
19295.66 |
Total Medicare Payment Amount |
14757.16 |
Total Medicare Standardized Payment Amount |
13821.87 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
17 |
Number Of Medicare Beneficiaries With Drug Services |
17 |
Total Drug Submitted ChargeAmount |
650 |
Total Drug Medicare AllowedAmount |
232.64 |
Total Drug Medicare PaymentAmount |
228 |
Total Drug Medicare Standardized Payment Amount |
228 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
8 |
Number Of Medical Services |
243 |
Number Of Medicare Beneficiaries With Medical Services |
57 |
Total Medical Submitted Charge Amount |
22468 |
Total Medical Medicare Allowed Amount |
19063.02 |
Total Medical Medicare Payment Amount |
14529.16 |
Total Medical Medicare Standardized Payment Amount |
13593.87 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
20 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
15 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
32 |
Number Of Male Beneficiaries |
25 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
0 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
46 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
0 |
Number Of Beneficiaries With Medicare Only Entitlement |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
58 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
37 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
28 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.8669 |