| National Provider Identifier [NPI]: | 1326023839 |
| Last Name Of The Provider | EXTRA-MENDOZA |
| First Name Of The Provider | EDITA |
| 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 | 514 E WHITEHOUSE CANYON RD |
| Street Address 2 Of The Provider | STE110 |
| City Of The Provider | GREEN VALLEY |
| Zip Code Of The Provider | 856140538 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 188 |
| Number Of Services | 16039 |
| Number Of Medicare Beneficiaries | 878 |
| Total Submitted Charge Amount | 897069.8 |
| Total Medicare Allowed Amount | 464738.26 |
| Total Medicare Payment Amount | 378698.85 |
| Total Medicare Standardized Payment Amount | 385441.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1766 |
| Number Of Medicare Beneficiaries With Drug Services | 203 |
| Total Drug Submitted ChargeAmount | 29816.5 |
| Total Drug Medicare AllowedAmount | 13511.2 |
| Total Drug Medicare PaymentAmount | 11836.02 |
| Total Drug Medicare Standardized Payment Amount | 11836.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 174 |
| Number Of Medical Services | 14273 |
| Number Of Medicare Beneficiaries With Medical Services | 878 |
| Total Medical Submitted Charge Amount | 867253.3 |
| Total Medical Medicare Allowed Amount | 451227.06 |
| Total Medical Medicare Payment Amount | 366862.83 |
| Total Medical Medicare Standardized Payment Amount | 373605.22 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 471 |
| Number Of Beneficiaries Age 75 to 84 | 282 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 716 |
| Number Of Male Beneficiaries | 162 |
| Number Of Non Hispanic White Beneficiaries | 821 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8884 |