| National Provider Identifier [NPI]: | 1548266505 |
| Last Name Of The Provider | DOMINGUEZ |
| First Name Of The Provider | CARLOS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5400 W HILLSDALE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | VISALIA |
| Zip Code Of The Provider | 932918222 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1317 |
| Number Of Medicare Beneficiaries | 332 |
| Total Submitted Charge Amount | 94595.7 |
| Total Medicare Allowed Amount | 93018.11 |
| Total Medicare Payment Amount | 61466.76 |
| Total Medicare Standardized Payment Amount | 60609.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 129 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 2091.89 |
| Total Drug Medicare AllowedAmount | 1989.75 |
| Total Drug Medicare PaymentAmount | 1903.02 |
| Total Drug Medicare Standardized Payment Amount | 1903.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 1188 |
| Number Of Medicare Beneficiaries With Medical Services | 332 |
| Total Medical Submitted Charge Amount | 92503.81 |
| Total Medical Medicare Allowed Amount | 91028.36 |
| Total Medical Medicare Payment Amount | 59563.74 |
| Total Medical Medicare Standardized Payment Amount | 58706.1 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 155 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 160 |
| Number Of Male Beneficiaries | 172 |
| Number Of Non Hispanic White Beneficiaries | 184 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 280 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 6 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9237 |