National Provider Identifier [NPI]: |
1003802174 |
Last Name Of The Provider |
ROCHE |
First Name Of The Provider |
STEVE |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
12850 HILLCREST RD |
Street Address 2 Of The Provider |
SUITE F-206 |
City Of The Provider |
DALLAS |
Zip Code Of The Provider |
752301529 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Psychiatry |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
7 |
Number Of Services |
4496 |
Number Of Medicare Beneficiaries |
325 |
Total Submitted Charge Amount |
376630.32 |
Total Medicare Allowed Amount |
346630.38 |
Total Medicare Payment Amount |
267811.86 |
Total Medicare Standardized Payment Amount |
214234.95 |
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 |
7 |
Number Of Medical Services |
4496 |
Number Of Medicare Beneficiaries With Medical Services |
325 |
Total Medical Submitted Charge Amount |
376630.32 |
Total Medical Medicare Allowed Amount |
346630.38 |
Total Medical Medicare Payment Amount |
267811.86 |
Total Medical Medicare Standardized Payment Amount |
214234.95 |
Average Age Of Beneficiaries |
53 |
Number Of Beneficiaries Age Less65 |
230 |
Number Of Beneficiaries Age 65 to 74 |
71 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
159 |
Number Of Male Beneficiaries |
166 |
Number Of Non Hispanic White Beneficiaries |
214 |
Number Of Black or African American Beneficiaries |
81 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
161 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
164 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
18 |
Percent Of With Cancer |
6 |
Percent Of With Heart Failure |
16 |
Percent Of With Chronic Kidney Disease |
22 |
Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
Percent Of With Depression |
75 |
Percent Of With Diabetes |
28 |
Percent Of With Hyperlipidemia |
40 |
Percent Of With Hypertension |
66 |
Percent Of With Ischemic Heart Disease |
25 |
Percent Of With Osteoporosis |
7 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
61 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4823 |