| National Provider Identifier [NPI]: | 1487695037 |
| Last Name Of The Provider | HANSEN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4375 BOOTH CALLOWAY RD |
| Street Address 2 Of The Provider | SUITE 410 |
| City Of The Provider | NORTH RICHLAND HILLS |
| Zip Code Of The Provider | 761808359 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 869 |
| Number Of Medicare Beneficiaries | 193 |
| Total Submitted Charge Amount | 231882 |
| Total Medicare Allowed Amount | 100960.96 |
| Total Medicare Payment Amount | 78181.01 |
| Total Medicare Standardized Payment Amount | 83435.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 126 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 4016 |
| Total Drug Medicare AllowedAmount | 199.92 |
| Total Drug Medicare PaymentAmount | 156.9 |
| Total Drug Medicare Standardized Payment Amount | 156.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 743 |
| Number Of Medicare Beneficiaries With Medical Services | 193 |
| Total Medical Submitted Charge Amount | 227866 |
| Total Medical Medicare Allowed Amount | 100761.04 |
| Total Medical Medicare Payment Amount | 78024.11 |
| Total Medical Medicare Standardized Payment Amount | 83278.38 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 60 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 162 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 165 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 28 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5037 |