National Provider Identifier [NPI]: |
1083870562 |
Last Name Of The Provider |
WANG |
First Name Of The Provider |
HARRISON |
Middle Initial Of The Provider |
F |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
200 W ARBOR DR |
Street Address 2 Of The Provider |
#8756 |
City Of The Provider |
SAN DIEGO |
Zip Code Of The Provider |
921039000 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Diagnostic Radiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
130 |
Number Of Services |
8091 |
Number Of Medicare Beneficiaries |
1007 |
Total Submitted Charge Amount |
803300 |
Total Medicare Allowed Amount |
171180.46 |
Total Medicare Payment Amount |
139466.71 |
Total Medicare Standardized Payment Amount |
134346.63 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
6613 |
Number Of Medicare Beneficiaries With Drug Services |
85 |
Total Drug Submitted ChargeAmount |
10236 |
Total Drug Medicare AllowedAmount |
2472.41 |
Total Drug Medicare PaymentAmount |
1938.36 |
Total Drug Medicare Standardized Payment Amount |
1938.36 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
124 |
Number Of Medical Services |
1478 |
Number Of Medicare Beneficiaries With Medical Services |
1007 |
Total Medical Submitted Charge Amount |
793064 |
Total Medical Medicare Allowed Amount |
168708.05 |
Total Medical Medicare Payment Amount |
137528.35 |
Total Medical Medicare Standardized Payment Amount |
132408.27 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
97 |
Number Of Beneficiaries Age 65 to 74 |
538 |
Number Of Beneficiaries Age 75 to 84 |
251 |
Number Of Beneficiaries Age Greater 84 |
121 |
Number Of Female Beneficiaries |
713 |
Number Of Male Beneficiaries |
294 |
Number Of Non Hispanic White Beneficiaries |
882 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
22 |
Number Of Hispanic Beneficiaries |
80 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
887 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
120 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
4 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
16 |
Percent Of With Chronic Obstructive Pulmonary Disease |
10 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
20 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
19 |
Percent Of With Osteoporosis |
15 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
2 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
0.9892 |