| National Provider Identifier [NPI]: | 1053438846 |
| Last Name Of The Provider | HA |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LUFKIN |
| Zip Code Of The Provider | 759043163 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1334 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 94156 |
| Total Medicare Allowed Amount | 40467.26 |
| Total Medicare Payment Amount | 30065.85 |
| Total Medicare Standardized Payment Amount | 27341.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 344 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 7408 |
| Total Drug Medicare AllowedAmount | 787.83 |
| Total Drug Medicare PaymentAmount | 661.07 |
| Total Drug Medicare Standardized Payment Amount | 661.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 990 |
| Number Of Medicare Beneficiaries With Medical Services | 75 |
| Total Medical Submitted Charge Amount | 86748 |
| Total Medical Medicare Allowed Amount | 39679.43 |
| Total Medical Medicare Payment Amount | 29404.78 |
| Total Medical Medicare Standardized Payment Amount | 26680.41 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 33 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 35 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 50 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| 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 | 19 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.055 |