National Provider Identifier [NPI]: |
1972681963 |
Last Name Of The Provider |
WONG |
First Name Of The Provider |
LAWRENCE |
Middle Initial Of The Provider |
D |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2910 JEFFERSON ST |
Street Address 2 Of The Provider |
SUITE # 100 |
City Of The Provider |
CARLSBAD |
Zip Code Of The Provider |
920082356 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
612 |
Number Of Medicare Beneficiaries |
156 |
Total Submitted Charge Amount |
46478.72 |
Total Medicare Allowed Amount |
37248.52 |
Total Medicare Payment Amount |
25730.61 |
Total Medicare Standardized Payment Amount |
24788.07 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
5 |
Number Of Drug Services |
35 |
Number Of Medicare Beneficiaries With Drug Services |
29 |
Total Drug Submitted ChargeAmount |
1053.4 |
Total Drug Medicare AllowedAmount |
491.96 |
Total Drug Medicare PaymentAmount |
475.25 |
Total Drug Medicare Standardized Payment Amount |
475.25 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
26 |
Number Of Medical Services |
577 |
Number Of Medicare Beneficiaries With Medical Services |
156 |
Total Medical Submitted Charge Amount |
45425.32 |
Total Medical Medicare Allowed Amount |
36756.56 |
Total Medical Medicare Payment Amount |
25255.36 |
Total Medical Medicare Standardized Payment Amount |
24312.82 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
22 |
Number Of Beneficiaries Age 65 to 74 |
76 |
Number Of Beneficiaries Age 75 to 84 |
40 |
Number Of Beneficiaries Age Greater 84 |
18 |
Number Of Female Beneficiaries |
86 |
Number Of Male Beneficiaries |
70 |
Number Of Non Hispanic White Beneficiaries |
122 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
14 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
128 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
28 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
|
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
10 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
17 |
Percent Of With Diabetes |
17 |
Percent Of With Hyperlipidemia |
29 |
Percent Of With Hypertension |
41 |
Percent Of With Ischemic Heart Disease |
22 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9035 |