National Provider Identifier [NPI]: |
1558383802 |
Last Name Of The Provider |
MARTELL |
First Name Of The Provider |
JERRY |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11370 ANDERSON ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
LOMA LINDA |
Zip Code Of The Provider |
923543450 |
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 |
49 |
Number Of Services |
1677 |
Number Of Medicare Beneficiaries |
372 |
Total Submitted Charge Amount |
381084 |
Total Medicare Allowed Amount |
133876.92 |
Total Medicare Payment Amount |
100663.43 |
Total Medicare Standardized Payment Amount |
97223.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
263 |
Number Of Medicare Beneficiaries With Drug Services |
140 |
Total Drug Submitted ChargeAmount |
26403 |
Total Drug Medicare AllowedAmount |
8840.26 |
Total Drug Medicare PaymentAmount |
8605.47 |
Total Drug Medicare Standardized Payment Amount |
8605.47 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
38 |
Number Of Medical Services |
1414 |
Number Of Medicare Beneficiaries With Medical Services |
372 |
Total Medical Submitted Charge Amount |
354681 |
Total Medical Medicare Allowed Amount |
125036.66 |
Total Medical Medicare Payment Amount |
92057.96 |
Total Medical Medicare Standardized Payment Amount |
88617.83 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
84 |
Number Of Beneficiaries Age 65 to 74 |
146 |
Number Of Beneficiaries Age 75 to 84 |
110 |
Number Of Beneficiaries Age Greater 84 |
32 |
Number Of Female Beneficiaries |
201 |
Number Of Male Beneficiaries |
171 |
Number Of Non Hispanic White Beneficiaries |
192 |
Number Of Black or African American Beneficiaries |
59 |
Number Of AsianPacific Islander Beneficiaries |
16 |
Number Of Hispanic Beneficiaries |
91 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
192 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
180 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
12 |
Percent Of With Depression |
27 |
Percent Of With Diabetes |
35 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.281 |