| National Provider Identifier [NPI]: | 1609878115 |
| Last Name Of The Provider | WOODBURY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9089 BASELINE RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | RANCHO CUCAMONGA |
| Zip Code Of The Provider | 917301295 |
| 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 | 47 |
| Number Of Services | 2102 |
| Number Of Medicare Beneficiaries | 428 |
| Total Submitted Charge Amount | 166310 |
| Total Medicare Allowed Amount | 142193.77 |
| Total Medicare Payment Amount | 108149.09 |
| Total Medicare Standardized Payment Amount | 104763.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1785 |
| Total Drug Medicare AllowedAmount | 1284.09 |
| Total Drug Medicare PaymentAmount | 1258.26 |
| Total Drug Medicare Standardized Payment Amount | 1258.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2066 |
| Number Of Medicare Beneficiaries With Medical Services | 428 |
| Total Medical Submitted Charge Amount | 164525 |
| Total Medical Medicare Allowed Amount | 140909.68 |
| Total Medical Medicare Payment Amount | 106890.83 |
| Total Medical Medicare Standardized Payment Amount | 103504.88 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 133 |
| Number Of Beneficiaries Age 65 to 74 | 116 |
| Number Of Beneficiaries Age 75 to 84 | 116 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 240 |
| Number Of Male Beneficiaries | 188 |
| Number Of Non Hispanic White Beneficiaries | 156 |
| Number Of Black or African American Beneficiaries | 43 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 197 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 98 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 330 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.5002 |