National Provider Identifier [NPI]: |
1699879114 |
Last Name Of The Provider |
TON-THAT |
First Name Of The Provider |
QUYNH |
Middle Initial Of The Provider |
A |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
17051 NORTH DALLAS PARKWAY |
Street Address 2 Of The Provider |
SUITE 150 |
City Of The Provider |
ADDISON |
Zip Code Of The Provider |
75001 |
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 |
63 |
Number Of Services |
1073 |
Number Of Medicare Beneficiaries |
210 |
Total Submitted Charge Amount |
202268 |
Total Medicare Allowed Amount |
70626.72 |
Total Medicare Payment Amount |
52152.97 |
Total Medicare Standardized Payment Amount |
52035.15 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
171 |
Number Of Medicare Beneficiaries With Drug Services |
82 |
Total Drug Submitted ChargeAmount |
12334 |
Total Drug Medicare AllowedAmount |
4984.1 |
Total Drug Medicare PaymentAmount |
4824.97 |
Total Drug Medicare Standardized Payment Amount |
4824.97 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
49 |
Number Of Medical Services |
902 |
Number Of Medicare Beneficiaries With Medical Services |
210 |
Total Medical Submitted Charge Amount |
189934 |
Total Medical Medicare Allowed Amount |
65642.62 |
Total Medical Medicare Payment Amount |
47328 |
Total Medical Medicare Standardized Payment Amount |
47210.18 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
41 |
Number Of Beneficiaries Age 65 to 74 |
90 |
Number Of Beneficiaries Age 75 to 84 |
57 |
Number Of Beneficiaries Age Greater 84 |
22 |
Number Of Female Beneficiaries |
117 |
Number Of Male Beneficiaries |
93 |
Number Of Non Hispanic White Beneficiaries |
155 |
Number Of Black or African American Beneficiaries |
29 |
Number Of AsianPacific Islander Beneficiaries |
11 |
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 |
188 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
22 |
Percent Of With Atrial Fibrillation |
9 |
Percent Of With Alzheimers Disease or Dementia |
7 |
Percent Of With Asthma |
8 |
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
11 |
Percent Of With Chronic Kidney Disease |
17 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
23 |
Percent Of With Diabetes |
23 |
Percent Of With Hyperlipidemia |
56 |
Percent Of With Hypertension |
69 |
Percent Of With Ischemic Heart Disease |
21 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
33 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.9795 |