| National Provider Identifier [NPI]: | 1003830241 |
| Last Name Of The Provider | NGO |
| First Name Of The Provider | LAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12784 VETERANS MEMORIAL DR |
| Street Address 2 Of The Provider | FOOT CLINIC |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770142047 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1357 |
| Number Of Medicare Beneficiaries | 77 |
| Total Submitted Charge Amount | 47284.5 |
| Total Medicare Allowed Amount | 42303.27 |
| Total Medicare Payment Amount | 32690.98 |
| Total Medicare Standardized Payment Amount | 27430.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 228 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 907 |
| Total Drug Medicare AllowedAmount | 357.34 |
| Total Drug Medicare PaymentAmount | 280.13 |
| Total Drug Medicare Standardized Payment Amount | 280.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 1129 |
| Number Of Medicare Beneficiaries With Medical Services | 77 |
| Total Medical Submitted Charge Amount | 46377.5 |
| Total Medical Medicare Allowed Amount | 41945.93 |
| Total Medical Medicare Payment Amount | 32410.85 |
| Total Medical Medicare Standardized Payment Amount | 27150.28 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 32 |
| Number Of Beneficiaries Age 75 to 84 | 26 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 32 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 40 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.409 |