| National Provider Identifier [NPI]: | 1821138405 |
| Last Name Of The Provider | OLIVARES |
| First Name Of The Provider | GISELLA |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1770 N ORANGE GROVE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | POMONA |
| Zip Code Of The Provider | 917673027 |
| 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 | 32 |
| Number Of Services | 552 |
| Number Of Medicare Beneficiaries | 127 |
| Total Submitted Charge Amount | 69934.38 |
| Total Medicare Allowed Amount | 35046.44 |
| Total Medicare Payment Amount | 25959.88 |
| Total Medicare Standardized Payment Amount | 24966.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 89 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 2165 |
| Total Drug Medicare AllowedAmount | 926.85 |
| Total Drug Medicare PaymentAmount | 887.53 |
| Total Drug Medicare Standardized Payment Amount | 887.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 463 |
| Number Of Medicare Beneficiaries With Medical Services | 127 |
| Total Medical Submitted Charge Amount | 67769.38 |
| Total Medical Medicare Allowed Amount | 34119.59 |
| Total Medical Medicare Payment Amount | 25072.35 |
| Total Medical Medicare Standardized Payment Amount | 24079.38 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 22 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 94 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 34 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 93 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2505 |