| National Provider Identifier [NPI]: | 1659559334 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | TREY |
| Middle Initial Of The Provider | Q |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 PALOMINO LANE |
| Street Address 2 Of The Provider | # 100 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891064894 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 263 |
| Number Of Services | 9052 |
| Number Of Medicare Beneficiaries | 2329 |
| Total Submitted Charge Amount | 875110.96 |
| Total Medicare Allowed Amount | 212881.85 |
| Total Medicare Payment Amount | 161170.54 |
| Total Medicare Standardized Payment Amount | 158065.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 5409 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 15368.76 |
| Total Drug Medicare AllowedAmount | 1168.57 |
| Total Drug Medicare PaymentAmount | 915.92 |
| Total Drug Medicare Standardized Payment Amount | 915.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 257 |
| Number Of Medical Services | 3643 |
| Number Of Medicare Beneficiaries With Medical Services | 2329 |
| Total Medical Submitted Charge Amount | 859742.2 |
| Total Medical Medicare Allowed Amount | 211713.28 |
| Total Medical Medicare Payment Amount | 160254.62 |
| Total Medical Medicare Standardized Payment Amount | 157149.57 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 501 |
| Number Of Beneficiaries Age 65 to 74 | 917 |
| Number Of Beneficiaries Age 75 to 84 | 632 |
| Number Of Beneficiaries Age Greater 84 | 279 |
| Number Of Female Beneficiaries | 1215 |
| Number Of Male Beneficiaries | 1114 |
| Number Of Non Hispanic White Beneficiaries | 1618 |
| Number Of Black or African American Beneficiaries | 334 |
| Number Of AsianPacific Islander Beneficiaries | 129 |
| Number Of Hispanic Beneficiaries | 202 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1652 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 677 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 2.4232 |