National Provider Identifier [NPI]: |
1053571844 |
Last Name Of The Provider |
AMESQUITA |
First Name Of The Provider |
MICHAEL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
|
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1001 SAM PERRY BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
FREDERICKSBURG |
Zip Code Of The Provider |
224014453 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Emergency Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
1256 |
Number Of Medicare Beneficiaries |
810 |
Total Submitted Charge Amount |
487677.44 |
Total Medicare Allowed Amount |
144799.52 |
Total Medicare Payment Amount |
110715.08 |
Total Medicare Standardized Payment Amount |
113202.63 |
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 |
1256 |
Number Of Medicare Beneficiaries With Medical Services |
810 |
Total Medical Submitted Charge Amount |
487677.44 |
Total Medical Medicare Allowed Amount |
144799.52 |
Total Medical Medicare Payment Amount |
110715.08 |
Total Medical Medicare Standardized Payment Amount |
113202.63 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
144 |
Number Of Beneficiaries Age 65 to 74 |
265 |
Number Of Beneficiaries Age 75 to 84 |
237 |
Number Of Beneficiaries Age Greater 84 |
164 |
Number Of Female Beneficiaries |
488 |
Number Of Male Beneficiaries |
322 |
Number Of Non Hispanic White Beneficiaries |
626 |
Number Of Black or African American Beneficiaries |
149 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
23 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
632 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
178 |
Percent Of With Atrial Fibrillation |
21 |
Percent Of With Alzheimers Disease or Dementia |
24 |
Percent Of With Asthma |
17 |
Percent Of With Cancer |
15 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
40 |
Percent Of With Chronic Obstructive Pulmonary Disease |
31 |
Percent Of With Depression |
36 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
53 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
41 |
Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
Percent Of With Stroke |
13 |
Average HCC Risk Score Of Beneficiaries |
1.9308 |