| National Provider Identifier [NPI]: | 1467437863 |
| Last Name Of The Provider | PHAN |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8210 WALNUT HILL LN. |
| Street Address 2 Of The Provider | STE. 230 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 75231 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 5263 |
| Number Of Medicare Beneficiaries | 689 |
| Total Submitted Charge Amount | 384791 |
| Total Medicare Allowed Amount | 238826.55 |
| Total Medicare Payment Amount | 187525.01 |
| Total Medicare Standardized Payment Amount | 186971.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 285 |
| Number Of Medicare Beneficiaries With Drug Services | 251 |
| Total Drug Submitted ChargeAmount | 19535 |
| Total Drug Medicare AllowedAmount | 10779.54 |
| Total Drug Medicare PaymentAmount | 10469.79 |
| Total Drug Medicare Standardized Payment Amount | 10469.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 4978 |
| Number Of Medicare Beneficiaries With Medical Services | 689 |
| Total Medical Submitted Charge Amount | 365256 |
| Total Medical Medicare Allowed Amount | 228047.01 |
| Total Medical Medicare Payment Amount | 177055.22 |
| Total Medical Medicare Standardized Payment Amount | 176501.69 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 297 |
| Number Of Beneficiaries Age 75 to 84 | 263 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 380 |
| Number Of Male Beneficiaries | 309 |
| Number Of Non Hispanic White Beneficiaries | 581 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| 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 | 664 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.978 |