| National Provider Identifier [NPI]: | 1780791939 |
| Last Name Of The Provider | VICENTE |
| First Name Of The Provider | JOAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 S WELLS RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | VENTURA |
| Zip Code Of The Provider | 930041377 |
| 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 | 22 |
| Number Of Services | 1686 |
| Number Of Medicare Beneficiaries | 357 |
| Total Submitted Charge Amount | 142307 |
| Total Medicare Allowed Amount | 120856.48 |
| Total Medicare Payment Amount | 91588.54 |
| Total Medicare Standardized Payment Amount | 83466.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 255 |
| Number Of Medicare Beneficiaries With Drug Services | 171 |
| Total Drug Submitted ChargeAmount | 8607 |
| Total Drug Medicare AllowedAmount | 4725.37 |
| Total Drug Medicare PaymentAmount | 4603.13 |
| Total Drug Medicare Standardized Payment Amount | 4603.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 1431 |
| Number Of Medicare Beneficiaries With Medical Services | 357 |
| Total Medical Submitted Charge Amount | 133700 |
| Total Medical Medicare Allowed Amount | 116131.11 |
| Total Medical Medicare Payment Amount | 86985.41 |
| Total Medical Medicare Standardized Payment Amount | 78863.15 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 29 |
| Number Of Beneficiaries Age 65 to 74 | 175 |
| Number Of Beneficiaries Age 75 to 84 | 113 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 114 |
| Number Of Non Hispanic White Beneficiaries | 86 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 108 |
| Number Of Hispanic Beneficiaries | 108 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 77 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 6 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 24 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.0028 |