| National Provider Identifier [NPI]: | 1164651808 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | BREANNA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1730 W CHEW ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALLENTOWN |
| Zip Code Of The Provider | 181045549 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 969 |
| Number Of Medicare Beneficiaries | 281 |
| Total Submitted Charge Amount | 76599 |
| Total Medicare Allowed Amount | 49871.73 |
| Total Medicare Payment Amount | 28574.9 |
| Total Medicare Standardized Payment Amount | 30321.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 55 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 2060 |
| Total Drug Medicare AllowedAmount | 1469.46 |
| Total Drug Medicare PaymentAmount | 1423.03 |
| Total Drug Medicare Standardized Payment Amount | 1423.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 914 |
| Number Of Medicare Beneficiaries With Medical Services | 281 |
| Total Medical Submitted Charge Amount | 74539 |
| Total Medical Medicare Allowed Amount | 48402.27 |
| Total Medical Medicare Payment Amount | 27151.87 |
| Total Medical Medicare Standardized Payment Amount | 28898.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 95 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 133 |
| Number Of Male Beneficiaries | 148 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 270 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.989 |