National Provider Identifier [NPI]: |
1699798652 |
Last Name Of The Provider |
ENRIQUEZ |
First Name Of The Provider |
PEDRO |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
500 VONDERBURG DR |
Street Address 2 Of The Provider |
SUITE 102 |
City Of The Provider |
BRANDON |
Zip Code Of The Provider |
335115964 |
State Code Of The Provider |
FL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
75 |
Number Of Services |
4391 |
Number Of Medicare Beneficiaries |
368 |
Total Submitted Charge Amount |
370928.25 |
Total Medicare Allowed Amount |
252306.26 |
Total Medicare Payment Amount |
185074.51 |
Total Medicare Standardized Payment Amount |
185434.45 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
11 |
Number Of Drug Services |
502 |
Number Of Medicare Beneficiaries With Drug Services |
143 |
Total Drug Submitted ChargeAmount |
4440.75 |
Total Drug Medicare AllowedAmount |
2958.85 |
Total Drug Medicare PaymentAmount |
2625.27 |
Total Drug Medicare Standardized Payment Amount |
2625.27 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
64 |
Number Of Medical Services |
3889 |
Number Of Medicare Beneficiaries With Medical Services |
368 |
Total Medical Submitted Charge Amount |
366487.5 |
Total Medical Medicare Allowed Amount |
249347.41 |
Total Medical Medicare Payment Amount |
182449.24 |
Total Medical Medicare Standardized Payment Amount |
182809.18 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
46 |
Number Of Beneficiaries Age 65 to 74 |
163 |
Number Of Beneficiaries Age 75 to 84 |
113 |
Number Of Beneficiaries Age Greater 84 |
46 |
Number Of Female Beneficiaries |
234 |
Number Of Male Beneficiaries |
134 |
Number Of Non Hispanic White Beneficiaries |
202 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
144 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
268 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
100 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
15 |
Percent Of With Asthma |
15 |
Percent Of With Cancer |
13 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
25 |
Percent Of With Depression |
33 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
71 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
62 |
Percent Of With Osteoporosis |
16 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
45 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
8 |
Average HCC Risk Score Of Beneficiaries |
1.736 |