| National Provider Identifier [NPI]: | 1801057724 |
| Last Name Of The Provider | LAOWANSIRI |
| First Name Of The Provider | PANTHIPA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1576 BELLA CRUZ DR |
| Street Address 2 Of The Provider | SUITE 336 |
| City Of The Provider | THE VILLAGES |
| Zip Code Of The Provider | 321598969 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 6350 |
| Number Of Medicare Beneficiaries | 1475 |
| Total Submitted Charge Amount | 965392 |
| Total Medicare Allowed Amount | 646151.04 |
| Total Medicare Payment Amount | 502236.29 |
| Total Medicare Standardized Payment Amount | 499231.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 6350 |
| Number Of Medicare Beneficiaries With Medical Services | 1475 |
| Total Medical Submitted Charge Amount | 965392 |
| Total Medical Medicare Allowed Amount | 646151.04 |
| Total Medical Medicare Payment Amount | 502236.29 |
| Total Medical Medicare Standardized Payment Amount | 499231.89 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 143 |
| Number Of Beneficiaries Age 65 to 74 | 457 |
| Number Of Beneficiaries Age 75 to 84 | 575 |
| Number Of Beneficiaries Age Greater 84 | 300 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 798 |
| Number Of Non Hispanic White Beneficiaries | 1367 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1172 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 303 |
| Percent Of With Atrial Fibrillation | 34 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 50 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 73 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.7275 |