National Provider Identifier [NPI]: |
1013965599 |
Last Name Of The Provider |
ZEVALLOS |
First Name Of The Provider |
GABRIEL |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
215 MARION AVE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MCCOMB |
Zip Code Of The Provider |
396482705 |
State Code Of The Provider |
MS |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
1851 |
Number Of Medicare Beneficiaries |
619 |
Total Submitted Charge Amount |
202959 |
Total Medicare Allowed Amount |
144045.67 |
Total Medicare Payment Amount |
112482.53 |
Total Medicare Standardized Payment Amount |
118839.77 |
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 |
17 |
Number Of Medical Services |
1851 |
Number Of Medicare Beneficiaries With Medical Services |
619 |
Total Medical Submitted Charge Amount |
202959 |
Total Medical Medicare Allowed Amount |
144045.67 |
Total Medical Medicare Payment Amount |
112482.53 |
Total Medical Medicare Standardized Payment Amount |
118839.77 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
162 |
Number Of Beneficiaries Age 65 to 74 |
160 |
Number Of Beneficiaries Age 75 to 84 |
169 |
Number Of Beneficiaries Age Greater 84 |
128 |
Number Of Female Beneficiaries |
344 |
Number Of Male Beneficiaries |
275 |
Number Of Non Hispanic White Beneficiaries |
359 |
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 |
285 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
334 |
Percent Of With Atrial Fibrillation |
20 |
Percent Of With Alzheimers Disease or Dementia |
28 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
52 |
Percent Of With Chronic Kidney Disease |
51 |
Percent Of With Chronic Obstructive Pulmonary Disease |
36 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
54 |
Percent Of With Hyperlipidemia |
60 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
70 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
12 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
2.3611 |