| National Provider Identifier [NPI]: | 1114922457 |
| Last Name Of The Provider | MONHEIT |
| First Name Of The Provider | JACQUELINE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 504 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CONROE |
| Zip Code Of The Provider | 773042808 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 1124 |
| Number Of Medicare Beneficiaries | 397 |
| Total Submitted Charge Amount | 48727.5 |
| Total Medicare Allowed Amount | 39410.56 |
| Total Medicare Payment Amount | 30712.51 |
| Total Medicare Standardized Payment Amount | 23635.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 1124 |
| Number Of Medicare Beneficiaries With Medical Services | 397 |
| Total Medical Submitted Charge Amount | 48727.5 |
| Total Medical Medicare Allowed Amount | 39410.56 |
| Total Medical Medicare Payment Amount | 30712.51 |
| Total Medical Medicare Standardized Payment Amount | 23635.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 162 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 59 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 301 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 86 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7753 |