| National Provider Identifier [NPI]: | 1205876232 |
| Last Name Of The Provider | VICROY |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6560 FANNIN ST |
| Street Address 2 Of The Provider | SUITE 1012 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770302761 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 3653 |
| Number Of Medicare Beneficiaries | 307 |
| Total Submitted Charge Amount | 339215.56 |
| Total Medicare Allowed Amount | 136870.58 |
| Total Medicare Payment Amount | 109104.09 |
| Total Medicare Standardized Payment Amount | 103475.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 647 |
| Number Of Medicare Beneficiaries With Drug Services | 147 |
| Total Drug Submitted ChargeAmount | 24074 |
| Total Drug Medicare AllowedAmount | 11007.22 |
| Total Drug Medicare PaymentAmount | 9763.1 |
| Total Drug Medicare Standardized Payment Amount | 9763.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 3006 |
| Number Of Medicare Beneficiaries With Medical Services | 307 |
| Total Medical Submitted Charge Amount | 315141.56 |
| Total Medical Medicare Allowed Amount | 125863.36 |
| Total Medical Medicare Payment Amount | 99340.99 |
| Total Medical Medicare Standardized Payment Amount | 93712.4 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 147 |
| Number Of Beneficiaries Age 75 to 84 | 100 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 277 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 0.97 |