National Provider Identifier [NPI]: |
1982719597 |
Last Name Of The Provider |
DO |
First Name Of The Provider |
THOA |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
14350 BROOKHURST ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
GARDEN GROVE |
Zip Code Of The Provider |
928434608 |
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 |
7 |
Number Of Services |
848 |
Number Of Medicare Beneficiaries |
118 |
Total Submitted Charge Amount |
55443 |
Total Medicare Allowed Amount |
54289.41 |
Total Medicare Payment Amount |
40051.89 |
Total Medicare Standardized Payment Amount |
41718.93 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
65 |
Number Of Medicare Beneficiaries With Drug Services |
64 |
Total Drug Submitted ChargeAmount |
2002 |
Total Drug Medicare AllowedAmount |
848.41 |
Total Drug Medicare PaymentAmount |
831.49 |
Total Drug Medicare Standardized Payment Amount |
831.49 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
5 |
Number Of Medical Services |
783 |
Number Of Medicare Beneficiaries With Medical Services |
118 |
Total Medical Submitted Charge Amount |
53441 |
Total Medical Medicare Allowed Amount |
53441 |
Total Medical Medicare Payment Amount |
39220.4 |
Total Medical Medicare Standardized Payment Amount |
40887.44 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
11 |
Number Of Beneficiaries Age 65 to 74 |
56 |
Number Of Beneficiaries Age 75 to 84 |
39 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
54 |
Number Of Male Beneficiaries |
64 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
|
Percent Of With Diabetes |
38 |
Percent Of With Hyperlipidemia |
73 |
Percent Of With Hypertension |
72 |
Percent Of With Ischemic Heart Disease |
34 |
Percent Of With Osteoporosis |
18 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
47 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0296 |