National Provider Identifier [NPI]: |
1104009117 |
Last Name Of The Provider |
TAKAKI |
First Name Of The Provider |
KENNETH |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
DO |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
400 N PEPPER AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
COLTON |
Zip Code Of The Provider |
923241801 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
58 |
Number Of Services |
1619 |
Number Of Medicare Beneficiaries |
721 |
Total Submitted Charge Amount |
494312 |
Total Medicare Allowed Amount |
142789.21 |
Total Medicare Payment Amount |
110160.94 |
Total Medicare Standardized Payment Amount |
108886.61 |
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 |
58 |
Number Of Medical Services |
1619 |
Number Of Medicare Beneficiaries With Medical Services |
721 |
Total Medical Submitted Charge Amount |
494312 |
Total Medical Medicare Allowed Amount |
142789.21 |
Total Medical Medicare Payment Amount |
110160.94 |
Total Medical Medicare Standardized Payment Amount |
108886.61 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
262 |
Number Of Beneficiaries Age 65 to 74 |
208 |
Number Of Beneficiaries Age 75 to 84 |
154 |
Number Of Beneficiaries Age Greater 84 |
97 |
Number Of Female Beneficiaries |
394 |
Number Of Male Beneficiaries |
327 |
Number Of Non Hispanic White Beneficiaries |
290 |
Number Of Black or African American Beneficiaries |
151 |
Number Of AsianPacific Islander Beneficiaries |
41 |
Number Of Hispanic Beneficiaries |
223 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
200 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
521 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
49 |
Percent Of With Chronic Kidney Disease |
45 |
Percent Of With Chronic Obstructive Pulmonary Disease |
38 |
Percent Of With Depression |
40 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
50 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
51 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
18 |
Percent Of With Stroke |
12 |
Average HCC Risk Score Of Beneficiaries |
2.7699 |