| National Provider Identifier [NPI]: | 1972779734 |
| Last Name Of The Provider | ALPHONSO |
| First Name Of The Provider | HELENE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 855 MONTGOMERY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761072553 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 744 |
| Number Of Medicare Beneficiaries | 376 |
| Total Submitted Charge Amount | 105710 |
| Total Medicare Allowed Amount | 54839.39 |
| Total Medicare Payment Amount | 39175.27 |
| Total Medicare Standardized Payment Amount | 39734.26 |
| 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 | 10 |
| Number Of Medical Services | 744 |
| Number Of Medicare Beneficiaries With Medical Services | 376 |
| Total Medical Submitted Charge Amount | 105710 |
| Total Medical Medicare Allowed Amount | 54839.39 |
| Total Medical Medicare Payment Amount | 39175.27 |
| Total Medical Medicare Standardized Payment Amount | 39734.26 |
| Average Age Of Beneficiaries | 52 |
| Number Of Beneficiaries Age Less65 | 291 |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 238 |
| Number Of Male Beneficiaries | 138 |
| Number Of Non Hispanic White Beneficiaries | 274 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 157 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 219 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 25 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3087 |