| National Provider Identifier [NPI]: | 1497748156 |
| Last Name Of The Provider | ROMAN |
| First Name Of The Provider | JESUS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | SAN JUANCITY HOSPITAL |
| Street Address 2 Of The Provider | MEDICAL CENTER |
| City Of The Provider | SAN JUAN |
| Zip Code Of The Provider | 00936 |
| State Code Of The Provider | PR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 563 |
| Number Of Medicare Beneficiaries | 97 |
| Total Submitted Charge Amount | 26632.92 |
| Total Medicare Allowed Amount | 26571.49 |
| Total Medicare Payment Amount | 19535.56 |
| Total Medicare Standardized Payment Amount | 21163.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 177 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 274.35 |
| Total Drug Medicare AllowedAmount | 274.35 |
| Total Drug Medicare PaymentAmount | 189.76 |
| Total Drug Medicare Standardized Payment Amount | 189.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 386 |
| Number Of Medicare Beneficiaries With Medical Services | 97 |
| Total Medical Submitted Charge Amount | 26358.57 |
| Total Medical Medicare Allowed Amount | 26297.14 |
| Total Medical Medicare Payment Amount | 19345.8 |
| Total Medical Medicare Standardized Payment Amount | 20973.48 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 33 |
| Number Of Beneficiaries Age 75 to 84 | 23 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 59 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 58 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 73 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 3.1065 |