National Provider Identifier [NPI]: |
1225018302 |
Last Name Of The Provider |
HISE |
First Name Of The Provider |
LEO |
Middle Initial Of The Provider |
L |
Credentials Of The Provider |
D.O. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
4351 E LOHMAN AVE |
Street Address 2 Of The Provider |
SUITE 301 |
City Of The Provider |
LAS CRUCES |
Zip Code Of The Provider |
880118259 |
State Code Of The Provider |
NM |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Orthopedic Surgery |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
62 |
Number Of Services |
526 |
Number Of Medicare Beneficiaries |
94 |
Total Submitted Charge Amount |
180517 |
Total Medicare Allowed Amount |
48472.49 |
Total Medicare Payment Amount |
35861.73 |
Total Medicare Standardized Payment Amount |
38199.45 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
251 |
Number Of Medicare Beneficiaries With Drug Services |
12 |
Total Drug Submitted ChargeAmount |
8309 |
Total Drug Medicare AllowedAmount |
3057.92 |
Total Drug Medicare PaymentAmount |
2342.77 |
Total Drug Medicare Standardized Payment Amount |
2342.77 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
58 |
Number Of Medical Services |
275 |
Number Of Medicare Beneficiaries With Medical Services |
94 |
Total Medical Submitted Charge Amount |
172208 |
Total Medical Medicare Allowed Amount |
45414.57 |
Total Medical Medicare Payment Amount |
33518.96 |
Total Medical Medicare Standardized Payment Amount |
35856.68 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
23 |
Number Of Beneficiaries Age 65 to 74 |
36 |
Number Of Beneficiaries Age 75 to 84 |
23 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
62 |
Number Of Male Beneficiaries |
32 |
Number Of Non Hispanic White Beneficiaries |
68 |
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 |
72 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
18 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
14 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
28 |
Percent Of With Diabetes |
27 |
Percent Of With Hyperlipidemia |
62 |
Percent Of With Hypertension |
74 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
63 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2226 |