| National Provider Identifier [NPI]: | 1568471886 |
| Last Name Of The Provider | DOMINGUEZ |
| First Name Of The Provider | EMILIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 38051 MARKET SQUARE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ZEPHYRHILLS |
| Zip Code Of The Provider | 33542 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 69310 |
| Number Of Medicare Beneficiaries | 223 |
| Total Submitted Charge Amount | 284945 |
| Total Medicare Allowed Amount | 143370.24 |
| Total Medicare Payment Amount | 110566.76 |
| Total Medicare Standardized Payment Amount | 110267.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 67623 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 79967 |
| Total Drug Medicare AllowedAmount | 49853.82 |
| Total Drug Medicare PaymentAmount | 39016.52 |
| Total Drug Medicare Standardized Payment Amount | 39016.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 1687 |
| Number Of Medicare Beneficiaries With Medical Services | 223 |
| Total Medical Submitted Charge Amount | 204978 |
| Total Medical Medicare Allowed Amount | 93516.42 |
| Total Medical Medicare Payment Amount | 71550.24 |
| Total Medical Medicare Standardized Payment Amount | 71251.31 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 80 |
| Number Of Beneficiaries Age 75 to 84 | 66 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 118 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | 203 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 163 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.4301 |