| National Provider Identifier [NPI]: | 1720184401 |
| Last Name Of The Provider | ORTIZ |
| First Name Of The Provider | IVAN |
| 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 | 5959 GATEWAY BLVD W |
| Street Address 2 Of The Provider | STE. 120 |
| City Of The Provider | EL PASO |
| Zip Code Of The Provider | 799253331 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 276 |
| Number Of Medicare Beneficiaries | 252 |
| Total Submitted Charge Amount | 331384 |
| Total Medicare Allowed Amount | 37124.01 |
| Total Medicare Payment Amount | 28796.81 |
| Total Medicare Standardized Payment Amount | 30086.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 276 |
| Number Of Medicare Beneficiaries With Medical Services | 252 |
| Total Medical Submitted Charge Amount | 331384 |
| Total Medical Medicare Allowed Amount | 37124.01 |
| Total Medical Medicare Payment Amount | 28796.81 |
| Total Medical Medicare Standardized Payment Amount | 30086.95 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 60 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | 79 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 135 |
| Number Of Non Hispanic White Beneficiaries | 99 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 142 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 162 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.978 |