National Provider Identifier [NPI]: |
1831155787 |
Last Name Of The Provider |
BERHE |
First Name Of The Provider |
MEZGEBE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
3409 WORTH ST |
Street Address 2 Of The Provider |
710 |
City Of The Provider |
DALLAS |
Zip Code Of The Provider |
752462029 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Infectious Disease |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
67 |
Number Of Services |
178460 |
Number Of Medicare Beneficiaries |
698 |
Total Submitted Charge Amount |
3730155.2 |
Total Medicare Allowed Amount |
1339175.46 |
Total Medicare Payment Amount |
1015786.79 |
Total Medicare Standardized Payment Amount |
1018333.78 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
38 |
Number Of Drug Services |
174603 |
Number Of Medicare Beneficiaries With Drug Services |
237 |
Total Drug Submitted ChargeAmount |
2803614.2 |
Total Drug Medicare AllowedAmount |
1050912.11 |
Total Drug Medicare PaymentAmount |
798899.34 |
Total Drug Medicare Standardized Payment Amount |
798899.34 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
3857 |
Number Of Medicare Beneficiaries With Medical Services |
698 |
Total Medical Submitted Charge Amount |
926541 |
Total Medical Medicare Allowed Amount |
288263.35 |
Total Medical Medicare Payment Amount |
216887.45 |
Total Medical Medicare Standardized Payment Amount |
219434.44 |
Average Age Of Beneficiaries |
68 |
Number Of Beneficiaries Age Less65 |
224 |
Number Of Beneficiaries Age 65 to 74 |
247 |
Number Of Beneficiaries Age 75 to 84 |
156 |
Number Of Beneficiaries Age Greater 84 |
71 |
Number Of Female Beneficiaries |
417 |
Number Of Male Beneficiaries |
281 |
Number Of Non Hispanic White Beneficiaries |
478 |
Number Of Black or African American Beneficiaries |
145 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
46 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
12 |
Number Of Beneficiaries With Medicare Only Entitlement |
533 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
165 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
39 |
Percent Of With Chronic Kidney Disease |
53 |
Percent Of With Chronic Obstructive Pulmonary Disease |
23 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
47 |
Percent Of With Osteoporosis |
30 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
50 |
Percent Of With Schizophrenia Other PsychoticDisorders |
6 |
Percent Of With Stroke |
9 |
Average HCC Risk Score Of Beneficiaries |
2.7208 |