| National Provider Identifier [NPI]: | 1295761765 |
| Last Name Of The Provider | MOGROVEJO |
| First Name Of The Provider | GABRIELA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 180 OTAY LAKES RD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | BONITA |
| Zip Code Of The Provider | 919022443 |
| 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 | 42 |
| Number Of Services | 415 |
| Number Of Medicare Beneficiaries | 106 |
| Total Submitted Charge Amount | 57316.74 |
| Total Medicare Allowed Amount | 29350.53 |
| Total Medicare Payment Amount | 20485.8 |
| Total Medicare Standardized Payment Amount | 19851.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 6171.49 |
| Total Drug Medicare AllowedAmount | 3105.08 |
| Total Drug Medicare PaymentAmount | 3036.06 |
| Total Drug Medicare Standardized Payment Amount | 3036.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 347 |
| Number Of Medicare Beneficiaries With Medical Services | 106 |
| Total Medical Submitted Charge Amount | 51145.25 |
| Total Medical Medicare Allowed Amount | 26245.45 |
| Total Medical Medicare Payment Amount | 17449.74 |
| Total Medical Medicare Standardized Payment Amount | 16815.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 45 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 20 |
| Number Of Non Hispanic White Beneficiaries | 56 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 80 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| 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 | 18 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5219 |