| National Provider Identifier [NPI]: | 1255337051 |
| Last Name Of The Provider | HENDERSON |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 755 N 11TH ST |
| Street Address 2 Of The Provider | STE P-3200 |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777021501 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 8562 |
| Number Of Medicare Beneficiaries | 1960 |
| Total Submitted Charge Amount | 1485952 |
| Total Medicare Allowed Amount | 696925.49 |
| Total Medicare Payment Amount | 513300.32 |
| Total Medicare Standardized Payment Amount | 541151.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 944 |
| Number Of Medicare Beneficiaries With Drug Services | 136 |
| Total Drug Submitted ChargeAmount | 334610 |
| Total Drug Medicare AllowedAmount | 170196.78 |
| Total Drug Medicare PaymentAmount | 129901.92 |
| Total Drug Medicare Standardized Payment Amount | 129901.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 119 |
| Number Of Medical Services | 7618 |
| Number Of Medicare Beneficiaries With Medical Services | 1960 |
| Total Medical Submitted Charge Amount | 1151342 |
| Total Medical Medicare Allowed Amount | 526728.71 |
| Total Medical Medicare Payment Amount | 383398.4 |
| Total Medical Medicare Standardized Payment Amount | 411249.47 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 716 |
| Number Of Beneficiaries Age 75 to 84 | 795 |
| Number Of Beneficiaries Age Greater 84 | 313 |
| Number Of Female Beneficiaries | 561 |
| Number Of Male Beneficiaries | 1399 |
| Number Of Non Hispanic White Beneficiaries | 1725 |
| Number Of Black or African American Beneficiaries | 172 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 141 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2899 |