| National Provider Identifier [NPI]: | 1386778033 |
| Last Name Of The Provider | PHAN |
| First Name Of The Provider | CONG |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9333 BASELINE RD |
| Street Address 2 Of The Provider | STE. 150 |
| City Of The Provider | RANCHO CUCAMONGA |
| Zip Code Of The Provider | 917301350 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 6515 |
| Number Of Medicare Beneficiaries | 567 |
| Total Submitted Charge Amount | 1475341 |
| Total Medicare Allowed Amount | 651535.19 |
| Total Medicare Payment Amount | 510670.97 |
| Total Medicare Standardized Payment Amount | 498971.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 6155 |
| Total Drug Medicare AllowedAmount | 2398.87 |
| Total Drug Medicare PaymentAmount | 2350.28 |
| Total Drug Medicare Standardized Payment Amount | 2350.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 6444 |
| Number Of Medicare Beneficiaries With Medical Services | 567 |
| Total Medical Submitted Charge Amount | 1469186 |
| Total Medical Medicare Allowed Amount | 649136.32 |
| Total Medical Medicare Payment Amount | 508320.69 |
| Total Medical Medicare Standardized Payment Amount | 496621.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 125 |
| Number Of Female Beneficiaries | 295 |
| Number Of Male Beneficiaries | 272 |
| Number Of Non Hispanic White Beneficiaries | 308 |
| Number Of Black or African American Beneficiaries | 54 |
| Number Of AsianPacific Islander Beneficiaries | 76 |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 303 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 264 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 63 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 3.1664 |