| National Provider Identifier [NPI]: | 1659368330 |
| Last Name Of The Provider | LI |
| First Name Of The Provider | FAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6807 EMMETT F LOWRY EXPY |
| Street Address 2 Of The Provider | 103 |
| City Of The Provider | TEXAS CITY |
| Zip Code Of The Provider | 775912546 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 3349 |
| Number Of Medicare Beneficiaries | 551 |
| Total Submitted Charge Amount | 494473.54 |
| Total Medicare Allowed Amount | 242862.52 |
| Total Medicare Payment Amount | 175802.1 |
| Total Medicare Standardized Payment Amount | 175500.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 511 |
| Number Of Medicare Beneficiaries With Drug Services | 136 |
| Total Drug Submitted ChargeAmount | 17363.54 |
| Total Drug Medicare AllowedAmount | 6000.16 |
| Total Drug Medicare PaymentAmount | 5243.19 |
| Total Drug Medicare Standardized Payment Amount | 5243.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 2838 |
| Number Of Medicare Beneficiaries With Medical Services | 551 |
| Total Medical Submitted Charge Amount | 477110 |
| Total Medical Medicare Allowed Amount | 236862.36 |
| Total Medical Medicare Payment Amount | 170558.91 |
| Total Medical Medicare Standardized Payment Amount | 170257.16 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 139 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 144 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 333 |
| Number Of Male Beneficiaries | 218 |
| Number Of Non Hispanic White Beneficiaries | 394 |
| Number Of Black or African American Beneficiaries | 106 |
| 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 | 414 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 137 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5103 |