| National Provider Identifier [NPI]: | 1316042849 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | HAI |
| 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 | 4800 FREDERICKSBURG RD |
| Street Address 2 Of The Provider | STE 127 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782293628 |
| 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 | 24 |
| Number Of Services | 2449 |
| Number Of Medicare Beneficiaries | 388 |
| Total Submitted Charge Amount | 272228.34 |
| Total Medicare Allowed Amount | 227177.39 |
| Total Medicare Payment Amount | 171630.52 |
| Total Medicare Standardized Payment Amount | 178981.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 56 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 1041.8 |
| Total Drug Medicare AllowedAmount | 979.84 |
| Total Drug Medicare PaymentAmount | 960.13 |
| Total Drug Medicare Standardized Payment Amount | 960.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 2393 |
| Number Of Medicare Beneficiaries With Medical Services | 388 |
| Total Medical Submitted Charge Amount | 271186.54 |
| Total Medical Medicare Allowed Amount | 226197.55 |
| Total Medical Medicare Payment Amount | 170670.39 |
| Total Medical Medicare Standardized Payment Amount | 178021.43 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 170 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 228 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 140 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 259 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 57 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0239 |