| National Provider Identifier [NPI]: | 1679706386 |
| Last Name Of The Provider | HAGOS |
| First Name Of The Provider | ELILTA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D., M.P.H |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2330 W COVELL BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAVIS |
| Zip Code Of The Provider | 956165658 |
| 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 | 23 |
| Number Of Services | 268 |
| Number Of Medicare Beneficiaries | 118 |
| Total Submitted Charge Amount | 56011 |
| Total Medicare Allowed Amount | 18206.65 |
| Total Medicare Payment Amount | 12206.11 |
| Total Medicare Standardized Payment Amount | 11955.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 2436 |
| Total Drug Medicare AllowedAmount | 696.45 |
| Total Drug Medicare PaymentAmount | 679.36 |
| Total Drug Medicare Standardized Payment Amount | 679.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 231 |
| Number Of Medicare Beneficiaries With Medical Services | 118 |
| Total Medical Submitted Charge Amount | 53575 |
| Total Medical Medicare Allowed Amount | 17510.2 |
| Total Medical Medicare Payment Amount | 11526.75 |
| Total Medical Medicare Standardized Payment Amount | 11276.37 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 83 |
| Number Of Male Beneficiaries | 35 |
| Number Of Non Hispanic White Beneficiaries | 77 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 87 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| 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 | |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8571 |