| National Provider Identifier [NPI]: | 1174500052 |
| Last Name Of The Provider | ECHANIQUE |
| First Name Of The Provider | CAMILO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 40 HART ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW BRITAIN |
| Zip Code Of The Provider | 060521743 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 589 |
| Number Of Medicare Beneficiaries | 405 |
| Total Submitted Charge Amount | 97512 |
| Total Medicare Allowed Amount | 53323.84 |
| Total Medicare Payment Amount | 30752.02 |
| Total Medicare Standardized Payment Amount | 28481.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 445 |
| Total Drug Medicare AllowedAmount | 390.96 |
| Total Drug Medicare PaymentAmount | 378.53 |
| Total Drug Medicare Standardized Payment Amount | 378.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 576 |
| Number Of Medicare Beneficiaries With Medical Services | 405 |
| Total Medical Submitted Charge Amount | 97067 |
| Total Medical Medicare Allowed Amount | 52932.88 |
| Total Medical Medicare Payment Amount | 30373.49 |
| Total Medical Medicare Standardized Payment Amount | 28102.89 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 162 |
| Number Of Beneficiaries Age Greater 84 | 120 |
| Number Of Female Beneficiaries | 229 |
| Number Of Male Beneficiaries | 176 |
| Number Of Non Hispanic White Beneficiaries | 362 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 314 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3668 |