| National Provider Identifier [NPI]: | 1811910235 |
| Last Name Of The Provider | RETAILLIAU |
| First Name Of The Provider | HENRY |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 315 MARTIN LUTHER KING JR WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984054234 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 2773 |
| Number Of Medicare Beneficiaries | 668 |
| Total Submitted Charge Amount | 378334 |
| Total Medicare Allowed Amount | 191024.29 |
| Total Medicare Payment Amount | 138762.05 |
| Total Medicare Standardized Payment Amount | 139967.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 416 |
| Number Of Medicare Beneficiaries With Drug Services | 244 |
| Total Drug Submitted ChargeAmount | 30779 |
| Total Drug Medicare AllowedAmount | 22715.48 |
| Total Drug Medicare PaymentAmount | 22192.78 |
| Total Drug Medicare Standardized Payment Amount | 22192.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 2357 |
| Number Of Medicare Beneficiaries With Medical Services | 668 |
| Total Medical Submitted Charge Amount | 347555 |
| Total Medical Medicare Allowed Amount | 168308.81 |
| Total Medical Medicare Payment Amount | 116569.27 |
| Total Medical Medicare Standardized Payment Amount | 117774.75 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 231 |
| Number Of Beneficiaries Age Greater 84 | 189 |
| Number Of Female Beneficiaries | 383 |
| Number Of Male Beneficiaries | 285 |
| Number Of Non Hispanic White Beneficiaries | 604 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 613 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2016 |