| National Provider Identifier [NPI]: | 1013902071 |
| Last Name Of The Provider | ERTZNER |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3226 S ALAMEDA ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784042508 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 190 |
| Number Of Services | 8361 |
| Number Of Medicare Beneficiaries | 3904 |
| Total Submitted Charge Amount | 459381.5 |
| Total Medicare Allowed Amount | 177297.52 |
| Total Medicare Payment Amount | 132368.23 |
| Total Medicare Standardized Payment Amount | 141029.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2027 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1209.5 |
| Total Drug Medicare AllowedAmount | 480.38 |
| Total Drug Medicare PaymentAmount | 376.55 |
| Total Drug Medicare Standardized Payment Amount | 376.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 6334 |
| Number Of Medicare Beneficiaries With Medical Services | 3904 |
| Total Medical Submitted Charge Amount | 458172 |
| Total Medical Medicare Allowed Amount | 176817.14 |
| Total Medical Medicare Payment Amount | 131991.68 |
| Total Medical Medicare Standardized Payment Amount | 140652.62 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 875 |
| Number Of Beneficiaries Age 65 to 74 | 1324 |
| Number Of Beneficiaries Age 75 to 84 | 1062 |
| Number Of Beneficiaries Age Greater 84 | 643 |
| Number Of Female Beneficiaries | 2203 |
| Number Of Male Beneficiaries | 1701 |
| Number Of Non Hispanic White Beneficiaries | 1769 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 1972 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2238 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1666 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.3246 |