| National Provider Identifier [NPI]: | 1053314393 |
| Last Name Of The Provider | STOUT |
| First Name Of The Provider | KEITH |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M. D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2010 DOWLEN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777062525 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 3482 |
| Number Of Medicare Beneficiaries | 377 |
| Total Submitted Charge Amount | 540426.93 |
| Total Medicare Allowed Amount | 223122.2 |
| Total Medicare Payment Amount | 172149.79 |
| Total Medicare Standardized Payment Amount | 178851.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 674 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 76069.72 |
| Total Drug Medicare AllowedAmount | 18485.23 |
| Total Drug Medicare PaymentAmount | 14653.24 |
| Total Drug Medicare Standardized Payment Amount | 14653.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 2808 |
| Number Of Medicare Beneficiaries With Medical Services | 377 |
| Total Medical Submitted Charge Amount | 464357.21 |
| Total Medical Medicare Allowed Amount | 204636.97 |
| Total Medical Medicare Payment Amount | 157496.55 |
| Total Medical Medicare Standardized Payment Amount | 164198.06 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 118 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 165 |
| Number Of Non Hispanic White Beneficiaries | 286 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 262 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 115 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1173 |