| National Provider Identifier [NPI]: | 1205818614 |
| Last Name Of The Provider | PAPPOE |
| First Name Of The Provider | TUTANKHAMEN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 650 W SOUTHERN AVE |
| Street Address 2 Of The Provider | 2 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852105012 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 7842 |
| Number Of Medicare Beneficiaries | 379 |
| Total Submitted Charge Amount | 1039727 |
| Total Medicare Allowed Amount | 522904.66 |
| Total Medicare Payment Amount | 400125.97 |
| Total Medicare Standardized Payment Amount | 378030.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1405 |
| Number Of Medicare Beneficiaries With Drug Services | 154 |
| Total Drug Submitted ChargeAmount | 6101 |
| Total Drug Medicare AllowedAmount | 1888.02 |
| Total Drug Medicare PaymentAmount | 1478.66 |
| Total Drug Medicare Standardized Payment Amount | 1478.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 6437 |
| Number Of Medicare Beneficiaries With Medical Services | 378 |
| Total Medical Submitted Charge Amount | 1033626 |
| Total Medical Medicare Allowed Amount | 521016.64 |
| Total Medical Medicare Payment Amount | 398647.31 |
| Total Medical Medicare Standardized Payment Amount | 376551.78 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 236 |
| Number Of Male Beneficiaries | 143 |
| Number Of Non Hispanic White Beneficiaries | 331 |
| Number Of Black or African American Beneficiaries | 21 |
| 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 | 335 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1453 |