National Provider Identifier [NPI]: |
1225095631 |
Last Name Of The Provider |
PHAM |
First Name Of The Provider |
CAO |
Middle Initial Of The Provider |
V |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
17742 BEACH BLVD |
Street Address 2 Of The Provider |
SUITE #230 |
City Of The Provider |
HUNTINGTON BEACH |
Zip Code Of The Provider |
926476835 |
State Code Of The Provider |
CA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Cardiology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
5189 |
Number Of Medicare Beneficiaries |
155 |
Total Submitted Charge Amount |
578300 |
Total Medicare Allowed Amount |
313970.8 |
Total Medicare Payment Amount |
234953.06 |
Total Medicare Standardized Payment Amount |
207438.01 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
146 |
Number Of Medicare Beneficiaries With Drug Services |
109 |
Total Drug Submitted ChargeAmount |
5550 |
Total Drug Medicare AllowedAmount |
4214.21 |
Total Drug Medicare PaymentAmount |
4129.62 |
Total Drug Medicare Standardized Payment Amount |
4129.62 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
28 |
Number Of Medical Services |
5043 |
Number Of Medicare Beneficiaries With Medical Services |
155 |
Total Medical Submitted Charge Amount |
572750 |
Total Medical Medicare Allowed Amount |
309756.59 |
Total Medical Medicare Payment Amount |
230823.44 |
Total Medical Medicare Standardized Payment Amount |
203308.39 |
Average Age Of Beneficiaries |
77 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
51 |
Number Of Beneficiaries Age 75 to 84 |
80 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
92 |
Number Of Male Beneficiaries |
63 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
140 |
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 |
38 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
117 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
11 |
Percent Of With Asthma |
53 |
Percent Of With Cancer |
|
Percent Of With Heart Failure |
75 |
Percent Of With Chronic Kidney Disease |
30 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
|
Percent Of With Diabetes |
75 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
14 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
34 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
2.0859 |