| National Provider Identifier [NPI]: | 1558523712 |
| Last Name Of The Provider | HUSTED |
| First Name Of The Provider | EVAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 S 11TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191074824 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 929 |
| Number Of Medicare Beneficiaries | 777 |
| Total Submitted Charge Amount | 1030323 |
| Total Medicare Allowed Amount | 155809.11 |
| Total Medicare Payment Amount | 120642.08 |
| Total Medicare Standardized Payment Amount | 115446.84 |
| 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 | 36 |
| Number Of Medical Services | 929 |
| Number Of Medicare Beneficiaries With Medical Services | 777 |
| Total Medical Submitted Charge Amount | 1030323 |
| Total Medical Medicare Allowed Amount | 155809.11 |
| Total Medical Medicare Payment Amount | 120642.08 |
| Total Medical Medicare Standardized Payment Amount | 115446.84 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 194 |
| Number Of Beneficiaries Age 75 to 84 | 227 |
| Number Of Beneficiaries Age Greater 84 | 259 |
| Number Of Female Beneficiaries | 446 |
| Number Of Male Beneficiaries | 331 |
| Number Of Non Hispanic White Beneficiaries | 675 |
| Number Of Black or African American Beneficiaries | 64 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| 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 | 661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 116 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 2.3802 |