National Provider Identifier [NPI]: |
1376829036 |
Last Name Of The Provider |
WHITE |
First Name Of The Provider |
HEBRON |
Middle Initial Of The Provider |
B |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3100 E FLETCHER AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
TAMPA |
Zip Code Of The Provider |
336134613 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
23 |
Number Of Services |
525 |
Number Of Medicare Beneficiaries |
455 |
Total Submitted Charge Amount |
537897 |
Total Medicare Allowed Amount |
82742.04 |
Total Medicare Payment Amount |
63007.79 |
Total Medicare Standardized Payment Amount |
62192.29 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
0 |
Number Of Drug Services |
0 |
Number Of Medicare Beneficiaries With Drug Services |
0 |
Total Drug Submitted ChargeAmount |
0 |
Total Drug Medicare AllowedAmount |
0 |
Total Drug Medicare PaymentAmount |
0 |
Total Drug Medicare Standardized Payment Amount |
0 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
23 |
Number Of Medical Services |
525 |
Number Of Medicare Beneficiaries With Medical Services |
455 |
Total Medical Submitted Charge Amount |
537897 |
Total Medical Medicare Allowed Amount |
82742.04 |
Total Medical Medicare Payment Amount |
63007.79 |
Total Medical Medicare Standardized Payment Amount |
62192.29 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
136 |
Number Of Beneficiaries Age 65 to 74 |
134 |
Number Of Beneficiaries Age 75 to 84 |
110 |
Number Of Beneficiaries Age Greater 84 |
75 |
Number Of Female Beneficiaries |
260 |
Number Of Male Beneficiaries |
195 |
Number Of Non Hispanic White Beneficiaries |
309 |
Number Of Black or African American Beneficiaries |
61 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
73 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
292 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
163 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
25 |
Percent Of With Asthma |
19 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
37 |
Percent Of With Chronic Obstructive Pulmonary Disease |
33 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
67 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
60 |
Percent Of With Osteoporosis |
11 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
11 |
Average HCC Risk Score Of Beneficiaries |
2.1001 |