| National Provider Identifier [NPI]: | 1295802890 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | ANGEL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | RR 2 BOX 5678 |
| Street Address 2 Of The Provider | |
| City Of The Provider | CIDRA |
| Zip Code Of The Provider | 007399679 |
| State Code Of The Provider | PR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 119 |
| Number Of Medicare Beneficiaries | 38 |
| Total Submitted Charge Amount | 3909.75 |
| Total Medicare Allowed Amount | 3697.08 |
| Total Medicare Payment Amount | 2610.35 |
| Total Medicare Standardized Payment Amount | 3959.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 148.6 |
| Total Drug Medicare AllowedAmount | 27.81 |
| Total Drug Medicare PaymentAmount | 20.91 |
| Total Drug Medicare Standardized Payment Amount | 20.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 85 |
| Number Of Medicare Beneficiaries With Medical Services | 38 |
| Total Medical Submitted Charge Amount | 3761.15 |
| Total Medical Medicare Allowed Amount | 3669.27 |
| Total Medical Medicare Payment Amount | 2589.44 |
| Total Medical Medicare Standardized Payment Amount | 3938.99 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 17 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 18 |
| Number Of Non Hispanic White Beneficiaries | 0 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 38 |
| 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 | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1372 |