| National Provider Identifier [NPI]: | 1962430413 |
| Last Name Of The Provider | LEVINE |
| First Name Of The Provider | MSONTHI |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3560 DELAWARE ST |
| Street Address 2 Of The Provider | SUITE 1104 |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777063067 |
| 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 | 68 |
| Number Of Services | 12847 |
| Number Of Medicare Beneficiaries | 1320 |
| Total Submitted Charge Amount | 9670936.52 |
| Total Medicare Allowed Amount | 894210.75 |
| Total Medicare Payment Amount | 680354.87 |
| Total Medicare Standardized Payment Amount | 723480.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2612 |
| Number Of Medicare Beneficiaries With Drug Services | 248 |
| Total Drug Submitted ChargeAmount | 132581.5 |
| Total Drug Medicare AllowedAmount | 1133.47 |
| Total Drug Medicare PaymentAmount | 975.8 |
| Total Drug Medicare Standardized Payment Amount | 975.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 10235 |
| Number Of Medicare Beneficiaries With Medical Services | 1320 |
| Total Medical Submitted Charge Amount | 9538355.02 |
| Total Medical Medicare Allowed Amount | 893077.28 |
| Total Medical Medicare Payment Amount | 679379.07 |
| Total Medical Medicare Standardized Payment Amount | 722504.33 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 312 |
| Number Of Beneficiaries Age 65 to 74 | 434 |
| Number Of Beneficiaries Age 75 to 84 | 359 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 764 |
| Number Of Male Beneficiaries | 556 |
| Number Of Non Hispanic White Beneficiaries | 784 |
| Number Of Black or African American Beneficiaries | 497 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 870 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 450 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8309 |