| National Provider Identifier [NPI]: | 1073513248 |
| Last Name Of The Provider | LUTZ |
| First Name Of The Provider | BROCK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 935 S BAXTER AVE |
| Street Address 2 Of The Provider | STE 103 |
| City Of The Provider | TYLER |
| Zip Code Of The Provider | 757012245 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 6501 |
| Number Of Medicare Beneficiaries | 688 |
| Total Submitted Charge Amount | 1071758.08 |
| Total Medicare Allowed Amount | 293801.54 |
| Total Medicare Payment Amount | 227641.35 |
| Total Medicare Standardized Payment Amount | 229456.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 3094 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 338700.84 |
| Total Drug Medicare AllowedAmount | 93416.03 |
| Total Drug Medicare PaymentAmount | 73243.61 |
| Total Drug Medicare Standardized Payment Amount | 73243.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 3407 |
| Number Of Medicare Beneficiaries With Medical Services | 688 |
| Total Medical Submitted Charge Amount | 733057.24 |
| Total Medical Medicare Allowed Amount | 200385.51 |
| Total Medical Medicare Payment Amount | 154397.74 |
| Total Medical Medicare Standardized Payment Amount | 156212.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 179 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 186 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 337 |
| Number Of Male Beneficiaries | 351 |
| Number Of Non Hispanic White Beneficiaries | 528 |
| Number Of Black or African American Beneficiaries | 132 |
| 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 | 467 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 221 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 3.0972 |