| National Provider Identifier [NPI]: | 1437231115 |
| Last Name Of The Provider | RIVERA |
| First Name Of The Provider | EDMUNDO |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 296 TREEMONT DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORANGE CITY |
| Zip Code Of The Provider | 327637945 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 1492 |
| Number Of Medicare Beneficiaries | 249 |
| Total Submitted Charge Amount | 173674 |
| Total Medicare Allowed Amount | 121824.95 |
| Total Medicare Payment Amount | 91694.74 |
| Total Medicare Standardized Payment Amount | 92958.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 1492 |
| Number Of Medicare Beneficiaries With Medical Services | 249 |
| Total Medical Submitted Charge Amount | 173674 |
| Total Medical Medicare Allowed Amount | 121824.95 |
| Total Medical Medicare Payment Amount | 91694.74 |
| Total Medical Medicare Standardized Payment Amount | 92958.08 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 90 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 170 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 175 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 188 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 74 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5477 |