| National Provider Identifier [NPI]: | 1447273594 |
| Last Name Of The Provider | BRAVO |
| First Name Of The Provider | ANDRES |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 460 N ELM ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ESCONDIDO |
| Zip Code Of The Provider | 920253002 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 13 |
| Number Of Services | 68 |
| Number Of Medicare Beneficiaries | 36 |
| Total Submitted Charge Amount | 1068 |
| Total Medicare Allowed Amount | 615.86 |
| Total Medicare Payment Amount | 562.52 |
| Total Medicare Standardized Payment Amount | 639.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 381 |
| Total Drug Medicare AllowedAmount | 193.45 |
| Total Drug Medicare PaymentAmount | 186.61 |
| Total Drug Medicare Standardized Payment Amount | 186.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 44 |
| Number Of Medicare Beneficiaries With Medical Services | 36 |
| Total Medical Submitted Charge Amount | 687 |
| Total Medical Medicare Allowed Amount | 422.41 |
| Total Medical Medicare Payment Amount | 375.91 |
| Total Medical Medicare Standardized Payment Amount | 452.97 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 16 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7428 |