National Provider Identifier [NPI]: |
1477544070 |
Last Name Of The Provider |
FINE |
First Name Of The Provider |
NATASHA |
Middle Initial Of The Provider |
W |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1201 ALHAMBRA BLVD |
Street Address 2 Of The Provider |
#330 |
City Of The Provider |
SACRAMENTO |
Zip Code Of The Provider |
958165238 |
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 |
35 |
Number Of Services |
476 |
Number Of Medicare Beneficiaries |
97 |
Total Submitted Charge Amount |
120860 |
Total Medicare Allowed Amount |
40764.27 |
Total Medicare Payment Amount |
29611.24 |
Total Medicare Standardized Payment Amount |
29032.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
50 |
Number Of Medicare Beneficiaries With Drug Services |
34 |
Total Drug Submitted ChargeAmount |
2321 |
Total Drug Medicare AllowedAmount |
1357.19 |
Total Drug Medicare PaymentAmount |
1326.03 |
Total Drug Medicare Standardized Payment Amount |
1326.03 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
426 |
Number Of Medicare Beneficiaries With Medical Services |
97 |
Total Medical Submitted Charge Amount |
118539 |
Total Medical Medicare Allowed Amount |
39407.08 |
Total Medical Medicare Payment Amount |
28285.21 |
Total Medical Medicare Standardized Payment Amount |
27706.12 |
Average Age Of Beneficiaries |
67 |
Number Of Beneficiaries Age Less65 |
29 |
Number Of Beneficiaries Age 65 to 74 |
45 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
65 |
Number Of Male Beneficiaries |
32 |
Number Of Non Hispanic White Beneficiaries |
67 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
11 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
55 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
42 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
20 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
32 |
Percent Of With Diabetes |
32 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
27 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2059 |