| National Provider Identifier [NPI]: | 1962464461 |
| Last Name Of The Provider | CARABALLO |
| First Name Of The Provider | ULISES |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1201 MONUMENT RD |
| Street Address 2 Of The Provider | SUITE 201B |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322257428 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1577 |
| Number Of Medicare Beneficiaries | 305 |
| Total Submitted Charge Amount | 292324.07 |
| Total Medicare Allowed Amount | 97552.58 |
| Total Medicare Payment Amount | 68677.2 |
| Total Medicare Standardized Payment Amount | 70922.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 280 |
| Number Of Medicare Beneficiaries With Drug Services | 99 |
| Total Drug Submitted ChargeAmount | 10547.42 |
| Total Drug Medicare AllowedAmount | 3680.66 |
| Total Drug Medicare PaymentAmount | 3317.41 |
| Total Drug Medicare Standardized Payment Amount | 3317.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 1297 |
| Number Of Medicare Beneficiaries With Medical Services | 305 |
| Total Medical Submitted Charge Amount | 281776.65 |
| Total Medical Medicare Allowed Amount | 93871.92 |
| Total Medical Medicare Payment Amount | 65359.79 |
| Total Medical Medicare Standardized Payment Amount | 67605.1 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 153 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 165 |
| Number Of Non Hispanic White Beneficiaries | 158 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 246 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0002 |