| National Provider Identifier [NPI]: | 1548283914 |
| Last Name Of The Provider | TEO |
| First Name Of The Provider | BENA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6340 IRVINE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | IRVINE |
| Zip Code Of The Provider | 92620 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 316 |
| Number Of Medicare Beneficiaries | 130 |
| Total Submitted Charge Amount | 30909.8 |
| Total Medicare Allowed Amount | 23108.37 |
| Total Medicare Payment Amount | 16747.23 |
| Total Medicare Standardized Payment Amount | 15380.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1299.8 |
| Total Drug Medicare AllowedAmount | 618.94 |
| Total Drug Medicare PaymentAmount | 600.43 |
| Total Drug Medicare Standardized Payment Amount | 600.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 284 |
| Number Of Medicare Beneficiaries With Medical Services | 130 |
| Total Medical Submitted Charge Amount | 29610 |
| Total Medical Medicare Allowed Amount | 22489.43 |
| Total Medical Medicare Payment Amount | 16146.8 |
| Total Medical Medicare Standardized Payment Amount | 14779.84 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 82 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 91 |
| Number Of Male Beneficiaries | 39 |
| Number Of Non Hispanic White Beneficiaries | 97 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 45 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7788 |