National Provider Identifier [NPI]: |
1447464730 |
Last Name Of The Provider |
PHAM |
First Name Of The Provider |
MAI |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
7315 212TH ST SW |
Street Address 2 Of The Provider |
SUITE 103 |
City Of The Provider |
EDMONDS |
Zip Code Of The Provider |
980267610 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
General Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
134 |
Number Of Services |
3872 |
Number Of Medicare Beneficiaries |
429 |
Total Submitted Charge Amount |
3442931 |
Total Medicare Allowed Amount |
1101607.65 |
Total Medicare Payment Amount |
851147.46 |
Total Medicare Standardized Payment Amount |
805806.24 |
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 |
134 |
Number Of Medical Services |
3872 |
Number Of Medicare Beneficiaries With Medical Services |
429 |
Total Medical Submitted Charge Amount |
3442931 |
Total Medical Medicare Allowed Amount |
1101607.65 |
Total Medical Medicare Payment Amount |
851147.46 |
Total Medical Medicare Standardized Payment Amount |
805806.24 |
Average Age Of Beneficiaries |
72 |
Number Of Beneficiaries Age Less65 |
77 |
Number Of Beneficiaries Age 65 to 74 |
160 |
Number Of Beneficiaries Age 75 to 84 |
135 |
Number Of Beneficiaries Age Greater 84 |
57 |
Number Of Female Beneficiaries |
241 |
Number Of Male Beneficiaries |
188 |
Number Of Non Hispanic White Beneficiaries |
283 |
Number Of Black or African American Beneficiaries |
53 |
Number Of AsianPacific Islander Beneficiaries |
58 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
17 |
Number Of Beneficiaries With Medicare Only Entitlement |
262 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
167 |
Percent Of With Atrial Fibrillation |
18 |
Percent Of With Alzheimers Disease or Dementia |
10 |
Percent Of With Asthma |
10 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
36 |
Percent Of With Chronic Kidney Disease |
56 |
Percent Of With Chronic Obstructive Pulmonary Disease |
14 |
Percent Of With Depression |
24 |
Percent Of With Diabetes |
44 |
Percent Of With Hyperlipidemia |
53 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
48 |
Percent Of With Osteoporosis |
8 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
36 |
Percent Of With Schizophrenia Other PsychoticDisorders |
3 |
Percent Of With Stroke |
7 |
Average HCC Risk Score Of Beneficiaries |
3.499 |