National Provider Identifier [NPI]: |
1114916061 |
Last Name Of The Provider |
BROWN |
First Name Of The Provider |
LANCE |
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 |
111 DALLAS ST |
Street Address 2 Of The Provider |
EMERGENCY ROOM |
City Of The Provider |
SAN ANTONIO |
Zip Code Of The Provider |
782051201 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
613 |
Number Of Medicare Beneficiaries |
333 |
Total Submitted Charge Amount |
280571.47 |
Total Medicare Allowed Amount |
61117.66 |
Total Medicare Payment Amount |
47359.65 |
Total Medicare Standardized Payment Amount |
48696.96 |
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 |
31 |
Number Of Medical Services |
613 |
Number Of Medicare Beneficiaries With Medical Services |
333 |
Total Medical Submitted Charge Amount |
280571.47 |
Total Medical Medicare Allowed Amount |
61117.66 |
Total Medical Medicare Payment Amount |
47359.65 |
Total Medical Medicare Standardized Payment Amount |
48696.96 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
97 |
Number Of Beneficiaries Age 65 to 74 |
89 |
Number Of Beneficiaries Age 75 to 84 |
78 |
Number Of Beneficiaries Age Greater 84 |
69 |
Number Of Female Beneficiaries |
211 |
Number Of Male Beneficiaries |
122 |
Number Of Non Hispanic White Beneficiaries |
157 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
151 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
211 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
122 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
30 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
35 |
Percent Of With Chronic Kidney Disease |
47 |
Percent Of With Chronic Obstructive Pulmonary Disease |
20 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
69 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
54 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
2.2878 |