| National Provider Identifier [NPI]: | 1720026438 |
| Last Name Of The Provider | VANDERHEYDEN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3719 DAUPHIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOBILE |
| Zip Code Of The Provider | 366081753 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 1591 |
| Number Of Medicare Beneficiaries | 890 |
| Total Submitted Charge Amount | 516921.53 |
| Total Medicare Allowed Amount | 147668.58 |
| Total Medicare Payment Amount | 110062.27 |
| Total Medicare Standardized Payment Amount | 117874.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 117 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 1660 |
| Total Drug Medicare AllowedAmount | 615.47 |
| Total Drug Medicare PaymentAmount | 471.5 |
| Total Drug Medicare Standardized Payment Amount | 471.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 70 |
| Number Of Medical Services | 1474 |
| Number Of Medicare Beneficiaries With Medical Services | 890 |
| Total Medical Submitted Charge Amount | 515261.53 |
| Total Medical Medicare Allowed Amount | 147053.11 |
| Total Medical Medicare Payment Amount | 109590.77 |
| Total Medical Medicare Standardized Payment Amount | 117402.52 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 285 |
| Number Of Beneficiaries Age 65 to 74 | 277 |
| Number Of Beneficiaries Age 75 to 84 | 216 |
| Number Of Beneficiaries Age Greater 84 | 112 |
| Number Of Female Beneficiaries | 510 |
| Number Of Male Beneficiaries | 380 |
| Number Of Non Hispanic White Beneficiaries | 571 |
| Number Of Black or African American Beneficiaries | 305 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 629 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 261 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6985 |