| National Provider Identifier [NPI]: | 1891776662 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | DOMINIQUE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1996 CENTRE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST ROXBURY |
| Zip Code Of The Provider | 021323329 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 5051 |
| Number Of Medicare Beneficiaries | 652 |
| Total Submitted Charge Amount | 664702 |
| Total Medicare Allowed Amount | 329451.63 |
| Total Medicare Payment Amount | 246236.22 |
| Total Medicare Standardized Payment Amount | 231734.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 335 |
| Number Of Medicare Beneficiaries With Drug Services | 255 |
| Total Drug Submitted ChargeAmount | 12949 |
| Total Drug Medicare AllowedAmount | 6282.04 |
| Total Drug Medicare PaymentAmount | 6078.81 |
| Total Drug Medicare Standardized Payment Amount | 6078.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 4716 |
| Number Of Medicare Beneficiaries With Medical Services | 652 |
| Total Medical Submitted Charge Amount | 651753 |
| Total Medical Medicare Allowed Amount | 323169.59 |
| Total Medical Medicare Payment Amount | 240157.41 |
| Total Medical Medicare Standardized Payment Amount | 225655.49 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 295 |
| Number Of Beneficiaries Age 75 to 84 | 199 |
| Number Of Beneficiaries Age Greater 84 | 113 |
| Number Of Female Beneficiaries | 358 |
| Number Of Male Beneficiaries | 294 |
| Number Of Non Hispanic White Beneficiaries | 596 |
| Number Of Black or African American Beneficiaries | 23 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 591 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.954 |