| National Provider Identifier [NPI]: | 1023004413 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JUSTIN |
| 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 | 801 INTERSTATE 20 W |
| Street Address 2 Of The Provider | STE 1 |
| City Of The Provider | ARLINGTON |
| Zip Code Of The Provider | 760175851 |
| 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 | 62 |
| Number Of Services | 2389 |
| Number Of Medicare Beneficiaries | 474 |
| Total Submitted Charge Amount | 414116 |
| Total Medicare Allowed Amount | 166769.92 |
| Total Medicare Payment Amount | 126781.12 |
| Total Medicare Standardized Payment Amount | 130194.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 1225 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 75449 |
| Total Drug Medicare AllowedAmount | 26016.49 |
| Total Drug Medicare PaymentAmount | 20318.59 |
| Total Drug Medicare Standardized Payment Amount | 20318.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 1164 |
| Number Of Medicare Beneficiaries With Medical Services | 474 |
| Total Medical Submitted Charge Amount | 338667 |
| Total Medical Medicare Allowed Amount | 140753.43 |
| Total Medical Medicare Payment Amount | 106462.53 |
| Total Medical Medicare Standardized Payment Amount | 109875.84 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 110 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 39 |
| Number Of Male Beneficiaries | 435 |
| Number Of Non Hispanic White Beneficiaries | 392 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 450 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 70 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0032 |