| National Provider Identifier [NPI]: | 1073559233 |
| Last Name Of The Provider | LEE-VILLANUEVA |
| First Name Of The Provider | BETTY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 N BRAND BLVD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 912032308 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 2821 |
| Number Of Medicare Beneficiaries | 2712 |
| Total Submitted Charge Amount | 430527 |
| Total Medicare Allowed Amount | 381256.91 |
| Total Medicare Payment Amount | 294799.69 |
| Total Medicare Standardized Payment Amount | 255932.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 4 |
| Number Of Medical Services | 2821 |
| Number Of Medicare Beneficiaries With Medical Services | 2712 |
| Total Medical Submitted Charge Amount | 430527 |
| Total Medical Medicare Allowed Amount | 381256.91 |
| Total Medical Medicare Payment Amount | 294799.69 |
| Total Medical Medicare Standardized Payment Amount | 255932.69 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 315 |
| Number Of Beneficiaries Age 65 to 74 | 553 |
| Number Of Beneficiaries Age 75 to 84 | 759 |
| Number Of Beneficiaries Age Greater 84 | 1085 |
| Number Of Female Beneficiaries | 1697 |
| Number Of Male Beneficiaries | 1015 |
| Number Of Non Hispanic White Beneficiaries | 1375 |
| Number Of Black or African American Beneficiaries | 356 |
| Number Of AsianPacific Islander Beneficiaries | 518 |
| Number Of Hispanic Beneficiaries | 405 |
| Number Of American Indian Alaska Native Beneficiaries | 19 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 215 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2497 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 67 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 22 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.4236 |