| National Provider Identifier [NPI]: | 1912013780 |
| Last Name Of The Provider | PHAN |
| First Name Of The Provider | DUNG |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1693 FLANIGAN DR |
| Street Address 2 Of The Provider | #100 |
| City Of The Provider | SAN JOSE |
| Zip Code Of The Provider | 95121 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 1091 |
| Number Of Medicare Beneficiaries | 244 |
| Total Submitted Charge Amount | 119995 |
| Total Medicare Allowed Amount | 97278.73 |
| Total Medicare Payment Amount | 75003.33 |
| Total Medicare Standardized Payment Amount | 64461.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 1290 |
| Total Drug Medicare AllowedAmount | 1134.48 |
| Total Drug Medicare PaymentAmount | 1111.8 |
| Total Drug Medicare Standardized Payment Amount | 1111.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 1041 |
| Number Of Medicare Beneficiaries With Medical Services | 243 |
| Total Medical Submitted Charge Amount | 118705 |
| Total Medical Medicare Allowed Amount | 96144.25 |
| Total Medical Medicare Payment Amount | 73891.53 |
| Total Medical Medicare Standardized Payment Amount | 63349.3 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 228 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 6 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 43 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8988 |