National Provider Identifier [NPI]: |
1770766834 |
Last Name Of The Provider |
VO |
First Name Of The Provider |
THOI |
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 |
7838 WESTMINSTER AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
WESTMINSTER |
Zip Code Of The Provider |
92683 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
11 |
Number Of Services |
450 |
Number Of Medicare Beneficiaries |
123 |
Total Submitted Charge Amount |
92250.09 |
Total Medicare Allowed Amount |
69210.05 |
Total Medicare Payment Amount |
54209.53 |
Total Medicare Standardized Payment Amount |
52615.32 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
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Number Of Drug Services |
|
Number Of Medicare Beneficiaries With Drug Services |
|
Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
|
Number Of Medical Services |
|
Number Of Medicare Beneficiaries With Medical Services |
|
Total Medical Submitted Charge Amount |
|
Total Medical Medicare Allowed Amount |
|
Total Medical Medicare Payment Amount |
|
Total Medical Medicare Standardized Payment Amount |
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Average Age Of Beneficiaries |
74 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
60 |
Number Of Beneficiaries Age 75 to 84 |
48 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
65 |
Number Of Male Beneficiaries |
58 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
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Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
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Number Of American Indian Alaska Native Beneficiaries |
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Number Of Beneficiaries With Race Not Else where Classified |
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Number Of Beneficiaries With Medicare Only Entitlement |
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Number Of Beneficiaries With Medicare Medicaid Entitlement |
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Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
23 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
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Percent Of With Heart Failure |
10 |
Percent Of With Chronic Kidney Disease |
24 |
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
11 |
Percent Of With Diabetes |
50 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
35 |
Percent Of With Osteoporosis |
25 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2024 |