| National Provider Identifier [NPI]: | 1568475614 |
| Last Name Of The Provider | NGUYEN |
| First Name Of The Provider | ETHAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 340 BANTAM RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITCHFIELD |
| Zip Code Of The Provider | 067593318 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 6221 |
| Number Of Medicare Beneficiaries | 1051 |
| Total Submitted Charge Amount | 625853.15 |
| Total Medicare Allowed Amount | 367204.85 |
| Total Medicare Payment Amount | 287589.46 |
| Total Medicare Standardized Payment Amount | 271727.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 7231 |
| Total Drug Medicare AllowedAmount | 6480.36 |
| Total Drug Medicare PaymentAmount | 6340.39 |
| Total Drug Medicare Standardized Payment Amount | 6340.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 6061 |
| Number Of Medicare Beneficiaries With Medical Services | 1051 |
| Total Medical Submitted Charge Amount | 618622.15 |
| Total Medical Medicare Allowed Amount | 360724.49 |
| Total Medical Medicare Payment Amount | 281249.07 |
| Total Medical Medicare Standardized Payment Amount | 265386.72 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 117 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 323 |
| Number Of Beneficiaries Age Greater 84 | 334 |
| Number Of Female Beneficiaries | 601 |
| Number Of Male Beneficiaries | 450 |
| Number Of Non Hispanic White Beneficiaries | 993 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 602 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 449 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7078 |