| National Provider Identifier [NPI]: | 1912093709 |
| Last Name Of The Provider | BOURQUE |
| First Name Of The Provider | THAD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1103 KALISTE SALOOM RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705085783 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 4672 |
| Number Of Medicare Beneficiaries | 998 |
| Total Submitted Charge Amount | 1228933.73 |
| Total Medicare Allowed Amount | 324678.31 |
| Total Medicare Payment Amount | 239452.21 |
| Total Medicare Standardized Payment Amount | 252002.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 878 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 477740 |
| Total Drug Medicare AllowedAmount | 89194.24 |
| Total Drug Medicare PaymentAmount | 68769.77 |
| Total Drug Medicare Standardized Payment Amount | 68769.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 95 |
| Number Of Medical Services | 3794 |
| Number Of Medicare Beneficiaries With Medical Services | 998 |
| Total Medical Submitted Charge Amount | 751193.73 |
| Total Medical Medicare Allowed Amount | 235484.07 |
| Total Medical Medicare Payment Amount | 170682.44 |
| Total Medical Medicare Standardized Payment Amount | 183233.13 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 165 |
| Number Of Beneficiaries Age 65 to 74 | 403 |
| Number Of Beneficiaries Age 75 to 84 | 344 |
| Number Of Beneficiaries Age Greater 84 | 86 |
| Number Of Female Beneficiaries | 229 |
| Number Of Male Beneficiaries | 769 |
| Number Of Non Hispanic White Beneficiaries | 759 |
| Number Of Black or African American Beneficiaries | 200 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 761 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 237 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1657 |