| National Provider Identifier [NPI]: | 1376547216 |
| Last Name Of The Provider | FORLANO |
| First Name Of The Provider | VIKI |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4235 SUNSET DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANGELO |
| Zip Code Of The Provider | 769045653 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 183 |
| Number Of Services | 7531 |
| Number Of Medicare Beneficiaries | 394 |
| Total Submitted Charge Amount | 219351.18 |
| Total Medicare Allowed Amount | 200011.19 |
| Total Medicare Payment Amount | 148173.96 |
| Total Medicare Standardized Payment Amount | 159286.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 1211 |
| Number Of Medicare Beneficiaries With Drug Services | 174 |
| Total Drug Submitted ChargeAmount | 14530.02 |
| Total Drug Medicare AllowedAmount | 13915.39 |
| Total Drug Medicare PaymentAmount | 11808.77 |
| Total Drug Medicare Standardized Payment Amount | 11808.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 6320 |
| Number Of Medicare Beneficiaries With Medical Services | 394 |
| Total Medical Submitted Charge Amount | 204821.16 |
| Total Medical Medicare Allowed Amount | 186095.8 |
| Total Medical Medicare Payment Amount | 136365.19 |
| Total Medical Medicare Standardized Payment Amount | 147477.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 200 |
| Number Of Beneficiaries Age 75 to 84 | 103 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 299 |
| Number Of Male Beneficiaries | 95 |
| Number Of Non Hispanic White Beneficiaries | 336 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 336 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0079 |