| National Provider Identifier [NPI]: | 1831131762 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | VICTOR |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3308 W. EDGEWOOD DR. |
| Street Address 2 Of The Provider | SUITE D |
| City Of The Provider | JEFFERSON CITY |
| Zip Code Of The Provider | 651096891 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Vascular Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 93 |
| Number Of Services | 1392 |
| Number Of Medicare Beneficiaries | 466 |
| Total Submitted Charge Amount | 2672176.19 |
| Total Medicare Allowed Amount | 976448.07 |
| Total Medicare Payment Amount | 752037.3 |
| Total Medicare Standardized Payment Amount | 871272.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 262 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 1798.39 |
| Total Drug Medicare AllowedAmount | 1314.24 |
| Total Drug Medicare PaymentAmount | 1029.22 |
| Total Drug Medicare Standardized Payment Amount | 1029.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 1130 |
| Number Of Medicare Beneficiaries With Medical Services | 466 |
| Total Medical Submitted Charge Amount | 2670377.8 |
| Total Medical Medicare Allowed Amount | 975133.83 |
| Total Medical Medicare Payment Amount | 751008.08 |
| Total Medical Medicare Standardized Payment Amount | 870243.33 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 182 |
| Number Of Beneficiaries Age Greater 84 | 68 |
| Number Of Female Beneficiaries | 231 |
| Number Of Male Beneficiaries | 235 |
| Number Of Non Hispanic White Beneficiaries | 451 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 404 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5052 |