| National Provider Identifier [NPI]: | 1598757114 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | WENDELL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19636 N 27TH AVE |
| Street Address 2 Of The Provider | SUITE 308 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850274013 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1204 |
| Number Of Medicare Beneficiaries | 291 |
| Total Submitted Charge Amount | 138915 |
| Total Medicare Allowed Amount | 86322.67 |
| Total Medicare Payment Amount | 61168.67 |
| Total Medicare Standardized Payment Amount | 62603.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 255 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 12606 |
| Total Drug Medicare AllowedAmount | 6410.02 |
| Total Drug Medicare PaymentAmount | 5739.95 |
| Total Drug Medicare Standardized Payment Amount | 5739.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 949 |
| Number Of Medicare Beneficiaries With Medical Services | 291 |
| Total Medical Submitted Charge Amount | 126309 |
| Total Medical Medicare Allowed Amount | 79912.65 |
| Total Medical Medicare Payment Amount | 55428.72 |
| Total Medical Medicare Standardized Payment Amount | 56863.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 151 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 157 |
| Number Of Male Beneficiaries | 134 |
| Number Of Non Hispanic White Beneficiaries | 276 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 266 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0581 |