| National Provider Identifier [NPI]: | 1588658298 |
| Last Name Of The Provider | HUESTON |
| First Name Of The Provider | ALLEN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 S 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WACO |
| Zip Code Of The Provider | 767011810 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 3447 |
| Number Of Medicare Beneficiaries | 113 |
| Total Submitted Charge Amount | 80299.51 |
| Total Medicare Allowed Amount | 66114 |
| Total Medicare Payment Amount | 46640.4 |
| Total Medicare Standardized Payment Amount | 48609.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2764 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 24718.25 |
| Total Drug Medicare AllowedAmount | 18006.54 |
| Total Drug Medicare PaymentAmount | 13823.59 |
| Total Drug Medicare Standardized Payment Amount | 13823.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 7 |
| Number Of Medical Services | 683 |
| Number Of Medicare Beneficiaries With Medical Services | 111 |
| Total Medical Submitted Charge Amount | 55581.26 |
| Total Medical Medicare Allowed Amount | 48107.46 |
| Total Medical Medicare Payment Amount | 32816.81 |
| Total Medical Medicare Standardized Payment Amount | 34785.69 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 59 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 54 |
| Number Of Black or African American Beneficiaries | 43 |
| 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 | 25 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 88 |
| Percent Of With Atrial Fibrillation | 0 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 58 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 63 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0543 |