| National Provider Identifier [NPI]: | 1336348218 |
| Last Name Of The Provider | FERNANDEZ |
| First Name Of The Provider | EDUARDO |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1430 HIGHWAY 96 E |
| Street Address 2 Of The Provider | |
| City Of The Provider | WHITE BEAR LAKE |
| Zip Code Of The Provider | 551103653 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 331 |
| Number Of Medicare Beneficiaries | 105 |
| Total Submitted Charge Amount | 41630 |
| Total Medicare Allowed Amount | 15327.09 |
| Total Medicare Payment Amount | 10414.82 |
| Total Medicare Standardized Payment Amount | 10787.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 721 |
| Total Drug Medicare AllowedAmount | 504.35 |
| Total Drug Medicare PaymentAmount | 458.16 |
| Total Drug Medicare Standardized Payment Amount | 458.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 277 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 40909 |
| Total Medical Medicare Allowed Amount | 14822.74 |
| Total Medical Medicare Payment Amount | 9956.66 |
| Total Medical Medicare Standardized Payment Amount | 10329.01 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 42 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 55 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 90 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 81 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| 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 | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9944 |