National Provider Identifier [NPI]: |
1508852468 |
Last Name Of The Provider |
SERRANO |
First Name Of The Provider |
ERIC |
Middle Initial Of The Provider |
R |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
475 HILL RD N |
Street Address 2 Of The Provider |
|
City Of The Provider |
PICKERINGTON |
Zip Code Of The Provider |
431471157 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
25 |
Number Of Services |
309 |
Number Of Medicare Beneficiaries |
49 |
Total Submitted Charge Amount |
32164 |
Total Medicare Allowed Amount |
16097.29 |
Total Medicare Payment Amount |
11141.72 |
Total Medicare Standardized Payment Amount |
11690.99 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
66 |
Number Of Medicare Beneficiaries With Drug Services |
19 |
Total Drug Submitted ChargeAmount |
4215 |
Total Drug Medicare AllowedAmount |
48.89 |
Total Drug Medicare PaymentAmount |
36.38 |
Total Drug Medicare Standardized Payment Amount |
36.38 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
19 |
Number Of Medical Services |
243 |
Number Of Medicare Beneficiaries With Medical Services |
49 |
Total Medical Submitted Charge Amount |
27949 |
Total Medical Medicare Allowed Amount |
16048.4 |
Total Medical Medicare Payment Amount |
11105.34 |
Total Medical Medicare Standardized Payment Amount |
11654.61 |
Average Age Of Beneficiaries |
66 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
25 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
22 |
Number Of Male Beneficiaries |
27 |
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 |
0 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
53 |
Percent Of With Hyperlipidemia |
|
Percent Of With Hypertension |
37 |
Percent Of With Ischemic Heart Disease |
31 |
Percent Of With Osteoporosis |
0 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
31 |
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.0831 |