| National Provider Identifier [NPI]: | 1912943424 |
| Last Name Of The Provider | NAN |
| First Name Of The Provider | CARMEN |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8425 NORTHCLIFFE BLVD |
| Street Address 2 Of The Provider | SUITE 105 |
| City Of The Provider | SPRING HILL |
| Zip Code Of The Provider | 346061107 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 2567 |
| Number Of Medicare Beneficiaries | 407 |
| Total Submitted Charge Amount | 363011.76 |
| Total Medicare Allowed Amount | 147523.61 |
| Total Medicare Payment Amount | 110957.4 |
| Total Medicare Standardized Payment Amount | 112170.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 496 |
| Number Of Medicare Beneficiaries With Drug Services | 199 |
| Total Drug Submitted ChargeAmount | 7215.51 |
| Total Drug Medicare AllowedAmount | 3343.98 |
| Total Drug Medicare PaymentAmount | 3184.73 |
| Total Drug Medicare Standardized Payment Amount | 3184.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 2071 |
| Number Of Medicare Beneficiaries With Medical Services | 407 |
| Total Medical Submitted Charge Amount | 355796.25 |
| Total Medical Medicare Allowed Amount | 144179.63 |
| Total Medical Medicare Payment Amount | 107772.67 |
| Total Medical Medicare Standardized Payment Amount | 108985.54 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 224 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 265 |
| Number Of Male Beneficiaries | 142 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9322 |