National Provider Identifier [NPI]: |
1336235167 |
Last Name Of The Provider |
BORCHARDT |
First Name Of The Provider |
ROY |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
PA |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1515 HOLCOMBE BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
HOUSTON |
Zip Code Of The Provider |
770304095 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Physician Assistant |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
5 |
Number Of Services |
589 |
Number Of Medicare Beneficiaries |
312 |
Total Submitted Charge Amount |
159564 |
Total Medicare Allowed Amount |
49369.52 |
Total Medicare Payment Amount |
38250.55 |
Total Medicare Standardized Payment Amount |
44812.3 |
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 |
5 |
Number Of Medical Services |
589 |
Number Of Medicare Beneficiaries With Medical Services |
312 |
Total Medical Submitted Charge Amount |
159564 |
Total Medical Medicare Allowed Amount |
49369.52 |
Total Medical Medicare Payment Amount |
38250.55 |
Total Medical Medicare Standardized Payment Amount |
44812.3 |
Average Age Of Beneficiaries |
69 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
174 |
Number Of Beneficiaries Age 75 to 84 |
66 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
119 |
Number Of Male Beneficiaries |
193 |
Number Of Non Hispanic White Beneficiaries |
225 |
Number Of Black or African American Beneficiaries |
35 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
35 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
269 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
43 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
8 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
35 |
Percent Of With Heart Failure |
32 |
Percent Of With Chronic Kidney Disease |
59 |
Percent Of With Chronic Obstructive Pulmonary Disease |
34 |
Percent Of With Depression |
35 |
Percent Of With Diabetes |
41 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
50 |
Percent Of With Osteoporosis |
12 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
42 |
Percent Of With Schizophrenia Other PsychoticDisorders |
8 |
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
3.3548 |