| National Provider Identifier [NPI]: | 1265489272 |
| Last Name Of The Provider | LIPSETT |
| First Name Of The Provider | ANNABELLE |
| 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 | HC 3 BOX 35675 |
| Street Address 2 Of The Provider | BO. CEIBA BAJA |
| City Of The Provider | AGUADILLA |
| Zip Code Of The Provider | 006039451 |
| State Code Of The Provider | PR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 417 |
| Number Of Medicare Beneficiaries | 34 |
| Total Submitted Charge Amount | 29547.96 |
| Total Medicare Allowed Amount | 16661.78 |
| Total Medicare Payment Amount | 13050.03 |
| Total Medicare Standardized Payment Amount | 13690.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 65 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 333.56 |
| Total Drug Medicare AllowedAmount | 255.44 |
| Total Drug Medicare PaymentAmount | 249.73 |
| Total Drug Medicare Standardized Payment Amount | 249.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 352 |
| Number Of Medicare Beneficiaries With Medical Services | 34 |
| Total Medical Submitted Charge Amount | 29214.4 |
| Total Medical Medicare Allowed Amount | 16406.34 |
| Total Medical Medicare Payment Amount | 12800.3 |
| Total Medical Medicare Standardized Payment Amount | 13441.25 |
| Average Age Of Beneficiaries | 54 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 15 |
| Number Of Male Beneficiaries | 19 |
| 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 | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 34 |
| 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 | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 62 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | |
| Percent Of With Hypertension | 32 |
| 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 | 1.0823 |