| National Provider Identifier [NPI]: | 1477656395 |
| Last Name Of The Provider | PHAN |
| First Name Of The Provider | DENISE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15243 VANOWEN ST |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | VAN NUYS |
| Zip Code Of The Provider | 914053605 |
| 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 | 129 |
| Number Of Services | 5086 |
| Number Of Medicare Beneficiaries | 230 |
| Total Submitted Charge Amount | 478081 |
| Total Medicare Allowed Amount | 265034.32 |
| Total Medicare Payment Amount | 210180.12 |
| Total Medicare Standardized Payment Amount | 195894.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 192 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 9335 |
| Total Drug Medicare AllowedAmount | 1990.81 |
| Total Drug Medicare PaymentAmount | 1744.89 |
| Total Drug Medicare Standardized Payment Amount | 1744.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 118 |
| Number Of Medical Services | 4894 |
| Number Of Medicare Beneficiaries With Medical Services | 230 |
| Total Medical Submitted Charge Amount | 468746 |
| Total Medical Medicare Allowed Amount | 263043.51 |
| Total Medical Medicare Payment Amount | 208435.23 |
| Total Medical Medicare Standardized Payment Amount | 194149.33 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 77 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 179 |
| Number Of Male Beneficiaries | 51 |
| Number Of Non Hispanic White Beneficiaries | 138 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4883 |