National Provider Identifier [NPI]: |
1568470706 |
Last Name Of The Provider |
BROOM |
First Name Of The Provider |
JOHN |
Middle Initial Of The Provider |
E |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
455 SAINT MICHAELS DR |
Street Address 2 Of The Provider |
|
City Of The Provider |
SANTA FE |
Zip Code Of The Provider |
875057601 |
State Code Of The Provider |
NM |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
15 |
Number Of Services |
1089 |
Number Of Medicare Beneficiaries |
349 |
Total Submitted Charge Amount |
351852 |
Total Medicare Allowed Amount |
106260.67 |
Total Medicare Payment Amount |
81820.87 |
Total Medicare Standardized Payment Amount |
76970.25 |
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 |
15 |
Number Of Medical Services |
1089 |
Number Of Medicare Beneficiaries With Medical Services |
349 |
Total Medical Submitted Charge Amount |
351852 |
Total Medical Medicare Allowed Amount |
106260.67 |
Total Medical Medicare Payment Amount |
81820.87 |
Total Medical Medicare Standardized Payment Amount |
76970.25 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
63 |
Number Of Beneficiaries Age 65 to 74 |
118 |
Number Of Beneficiaries Age 75 to 84 |
100 |
Number Of Beneficiaries Age Greater 84 |
68 |
Number Of Female Beneficiaries |
177 |
Number Of Male Beneficiaries |
172 |
Number Of Non Hispanic White Beneficiaries |
175 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
146 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
228 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
121 |
Percent Of With Atrial Fibrillation |
19 |
Percent Of With Alzheimers Disease or Dementia |
22 |
Percent Of With Asthma |
9 |
Percent Of With Cancer |
14 |
Percent Of With Heart Failure |
41 |
Percent Of With Chronic Kidney Disease |
48 |
Percent Of With Chronic Obstructive Pulmonary Disease |
29 |
Percent Of With Depression |
37 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
55 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
45 |
Percent Of With Osteoporosis |
16 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
Percent Of With Schizophrenia Other PsychoticDisorders |
9 |
Percent Of With Stroke |
16 |
Average HCC Risk Score Of Beneficiaries |
1.9312 |