| National Provider Identifier [NPI]: | 1609896687 |
| Last Name Of The Provider | CARBALLO |
| First Name Of The Provider | JORGE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 764 SW 18TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331353495 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 808 |
| Number Of Medicare Beneficiaries | 258 |
| Total Submitted Charge Amount | 86361 |
| Total Medicare Allowed Amount | 45034.11 |
| Total Medicare Payment Amount | 34791.79 |
| Total Medicare Standardized Payment Amount | 32363.62 |
| 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 | 9 |
| Number Of Medical Services | 808 |
| Number Of Medicare Beneficiaries With Medical Services | 258 |
| Total Medical Submitted Charge Amount | 86361 |
| Total Medical Medicare Allowed Amount | 45034.11 |
| Total Medical Medicare Payment Amount | 34791.79 |
| Total Medical Medicare Standardized Payment Amount | 32363.62 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 94 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 141 |
| Number Of Male Beneficiaries | 117 |
| Number Of Non Hispanic White Beneficiaries | 12 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 246 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 41 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 217 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 73 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6179 |