| National Provider Identifier [NPI]: | 1225070394 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8210 WALNUT HILL LN |
| Street Address 2 Of The Provider | SUITE 604 BLDG 1 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752314411 |
| 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 | 51 |
| Number Of Services | 3413 |
| Number Of Medicare Beneficiaries | 709 |
| Total Submitted Charge Amount | 402221.5 |
| Total Medicare Allowed Amount | 179452.53 |
| Total Medicare Payment Amount | 129507.38 |
| Total Medicare Standardized Payment Amount | 130718.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 147 |
| Number Of Medicare Beneficiaries With Drug Services | 137 |
| Total Drug Submitted ChargeAmount | 12594.5 |
| Total Drug Medicare AllowedAmount | 5632.1 |
| Total Drug Medicare PaymentAmount | 5507.99 |
| Total Drug Medicare Standardized Payment Amount | 5507.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 3266 |
| Number Of Medicare Beneficiaries With Medical Services | 709 |
| Total Medical Submitted Charge Amount | 389627 |
| Total Medical Medicare Allowed Amount | 173820.43 |
| Total Medical Medicare Payment Amount | 123999.39 |
| Total Medical Medicare Standardized Payment Amount | 125210.96 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 373 |
| Number Of Beneficiaries Age 75 to 84 | 220 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 390 |
| Number Of Male Beneficiaries | 319 |
| Number Of Non Hispanic White Beneficiaries | 662 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 694 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9336 |