| National Provider Identifier [NPI]: | 1346376803 |
| Last Name Of The Provider | DOMINGO-FORASTE |
| First Name Of The Provider | DIANNE |
| 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 | 2256 WHITTIER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900231243 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1137 |
| Number Of Medicare Beneficiaries | 182 |
| Total Submitted Charge Amount | 121674 |
| Total Medicare Allowed Amount | 71350.8 |
| Total Medicare Payment Amount | 51446.78 |
| Total Medicare Standardized Payment Amount | 46214.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 114 |
| Number Of Medicare Beneficiaries With Drug Services | 46 |
| Total Drug Submitted ChargeAmount | 790 |
| Total Drug Medicare AllowedAmount | 222.51 |
| Total Drug Medicare PaymentAmount | 181.93 |
| Total Drug Medicare Standardized Payment Amount | 181.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 1023 |
| Number Of Medicare Beneficiaries With Medical Services | 182 |
| Total Medical Submitted Charge Amount | 120884 |
| Total Medical Medicare Allowed Amount | 71128.29 |
| Total Medical Medicare Payment Amount | 51264.85 |
| Total Medical Medicare Standardized Payment Amount | 46032.71 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 113 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 160 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 39 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 143 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2956 |