| National Provider Identifier [NPI]: | 1982632055 |
| Last Name Of The Provider | KUPKA |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | BANNER BAYWOOD MEDICAL CENTER |
| Street Address 2 Of The Provider | 6644 E. BAYWOOD AVE |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852061797 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 885 |
| Number Of Medicare Beneficiaries | 815 |
| Total Submitted Charge Amount | 942083 |
| Total Medicare Allowed Amount | 145146.62 |
| Total Medicare Payment Amount | 112010.98 |
| Total Medicare Standardized Payment Amount | 112732.35 |
| 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 | 23 |
| Number Of Medical Services | 885 |
| Number Of Medicare Beneficiaries With Medical Services | 815 |
| Total Medical Submitted Charge Amount | 942083 |
| Total Medical Medicare Allowed Amount | 145146.62 |
| Total Medical Medicare Payment Amount | 112010.98 |
| Total Medical Medicare Standardized Payment Amount | 112732.35 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 251 |
| Number Of Beneficiaries Age 75 to 84 | 269 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 412 |
| Number Of Male Beneficiaries | 403 |
| Number Of Non Hispanic White Beneficiaries | 749 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 706 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 2.0772 |