| National Provider Identifier [NPI]: | 1386670479 |
| Last Name Of The Provider | GONZALES |
| First Name Of The Provider | EDIVINA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 29798 HAUN RD |
| Street Address 2 Of The Provider | SUITE 106 |
| City Of The Provider | SUN CITY |
| Zip Code Of The Provider | 925866541 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 548 |
| Number Of Medicare Beneficiaries | 95 |
| Total Submitted Charge Amount | 28924 |
| Total Medicare Allowed Amount | 24721.57 |
| Total Medicare Payment Amount | 16351.25 |
| Total Medicare Standardized Payment Amount | 15813.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 244 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 4795 |
| Total Drug Medicare AllowedAmount | 3286.42 |
| Total Drug Medicare PaymentAmount | 2695.58 |
| Total Drug Medicare Standardized Payment Amount | 2695.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 304 |
| Number Of Medicare Beneficiaries With Medical Services | 95 |
| Total Medical Submitted Charge Amount | 24129 |
| Total Medical Medicare Allowed Amount | 21435.15 |
| Total Medical Medicare Payment Amount | 13655.67 |
| Total Medical Medicare Standardized Payment Amount | 13117.87 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 79 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | 56 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 84 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7666 |