| National Provider Identifier [NPI]: | 1669568606 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 635 ANDERSON ROAD |
| Street Address 2 Of The Provider | #10 |
| City Of The Provider | DAVIS |
| Zip Code Of The Provider | 95616 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 799 |
| Number Of Medicare Beneficiaries | 193 |
| Total Submitted Charge Amount | 157111 |
| Total Medicare Allowed Amount | 54396.68 |
| Total Medicare Payment Amount | 40772.83 |
| Total Medicare Standardized Payment Amount | 39543.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 164 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 8522 |
| Total Drug Medicare AllowedAmount | 5304.06 |
| Total Drug Medicare PaymentAmount | 5038.1 |
| Total Drug Medicare Standardized Payment Amount | 5038.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 635 |
| Number Of Medicare Beneficiaries With Medical Services | 193 |
| Total Medical Submitted Charge Amount | 148589 |
| Total Medical Medicare Allowed Amount | 49092.62 |
| Total Medical Medicare Payment Amount | 35734.73 |
| Total Medical Medicare Standardized Payment Amount | 34505.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 156 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | 164 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| 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 | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8141 |