| National Provider Identifier [NPI]: | 1790799344 |
| Last Name Of The Provider | O'BRIEN-SU |
| First Name Of The Provider | EILEEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 731 E SOUTHLAKE BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | SOUTHLAKE |
| Zip Code Of The Provider | 760926377 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 230 |
| Number Of Medicare Beneficiaries | 37 |
| Total Submitted Charge Amount | 17024.2 |
| Total Medicare Allowed Amount | 9482.74 |
| Total Medicare Payment Amount | 6238.35 |
| Total Medicare Standardized Payment Amount | 6563.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1186 |
| Total Drug Medicare AllowedAmount | 834.15 |
| Total Drug Medicare PaymentAmount | 816.81 |
| Total Drug Medicare Standardized Payment Amount | 816.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 203 |
| Number Of Medicare Beneficiaries With Medical Services | 37 |
| Total Medical Submitted Charge Amount | 15838.2 |
| Total Medical Medicare Allowed Amount | 8648.59 |
| Total Medical Medicare Payment Amount | 5421.54 |
| Total Medical Medicare Standardized Payment Amount | 5746.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| 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 | 37 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8345 |