| National Provider Identifier [NPI]: | 1851403729 |
| Last Name Of The Provider | PERSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21 SPURS LANE |
| Street Address 2 Of The Provider | 310 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782401679 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 3232 |
| Number Of Medicare Beneficiaries | 499 |
| Total Submitted Charge Amount | 670578 |
| Total Medicare Allowed Amount | 243224.35 |
| Total Medicare Payment Amount | 180970.85 |
| Total Medicare Standardized Payment Amount | 191019.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1457 |
| Number Of Medicare Beneficiaries With Drug Services | 208 |
| Total Drug Submitted ChargeAmount | 26915 |
| Total Drug Medicare AllowedAmount | 15043.16 |
| Total Drug Medicare PaymentAmount | 11644.84 |
| Total Drug Medicare Standardized Payment Amount | 11644.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 130 |
| Number Of Medical Services | 1775 |
| Number Of Medicare Beneficiaries With Medical Services | 499 |
| Total Medical Submitted Charge Amount | 643663 |
| Total Medical Medicare Allowed Amount | 228181.19 |
| Total Medical Medicare Payment Amount | 169326.01 |
| Total Medical Medicare Standardized Payment Amount | 179374.22 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 276 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 289 |
| Number Of Male Beneficiaries | 210 |
| Number Of Non Hispanic White Beneficiaries | 389 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 88 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 459 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1786 |