| National Provider Identifier [NPI]: | 1568570349 |
| Last Name Of The Provider | VAUGHAN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 244 WESTERN AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH PORTLAND |
| Zip Code Of The Provider | 041062496 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 86 |
| Number Of Services | 867 |
| Number Of Medicare Beneficiaries | 207 |
| Total Submitted Charge Amount | 314058.1 |
| Total Medicare Allowed Amount | 103996.74 |
| Total Medicare Payment Amount | 78970.81 |
| Total Medicare Standardized Payment Amount | 73721.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 362 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 11431 |
| Total Drug Medicare AllowedAmount | 10511.24 |
| Total Drug Medicare PaymentAmount | 8234.22 |
| Total Drug Medicare Standardized Payment Amount | 8234.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 505 |
| Number Of Medicare Beneficiaries With Medical Services | 207 |
| Total Medical Submitted Charge Amount | 302627.1 |
| Total Medical Medicare Allowed Amount | 93485.5 |
| Total Medical Medicare Payment Amount | 70736.59 |
| Total Medical Medicare Standardized Payment Amount | 65487.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 151 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 56 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9855 |