| National Provider Identifier [NPI]: | 1053570184 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | VIET |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4775 HAMILTON WOLFE #1 |
| Street Address 2 Of The Provider | EAR, NOSE, AND THROAT CLINICS OF SAN ANTONIO |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 78229 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 1006 |
| Number Of Medicare Beneficiaries | 223 |
| Total Submitted Charge Amount | 165311 |
| Total Medicare Allowed Amount | 70385.48 |
| Total Medicare Payment Amount | 51902.47 |
| Total Medicare Standardized Payment Amount | 55193.65 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
| Number Of Medical Services | |
| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Total Medical Medicare Standardized Payment Amount | |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 93 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 139 |
| Number Of Male Beneficiaries | 84 |
| Number Of Non Hispanic White Beneficiaries | 107 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 103 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 167 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3384 |