| National Provider Identifier [NPI]: | 1629019708 |
| Last Name Of The Provider | BONILLA |
| First Name Of The Provider | LUIS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1580 VALENCIA ST |
| Street Address 2 Of The Provider | STE 803B |
| City Of The Provider | SAN FRANCISCO |
| Zip Code Of The Provider | 941104423 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 2064 |
| Number Of Medicare Beneficiaries | 384 |
| Total Submitted Charge Amount | 232874.72 |
| Total Medicare Allowed Amount | 197478.82 |
| Total Medicare Payment Amount | 134323.08 |
| Total Medicare Standardized Payment Amount | 113041.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 219 |
| Number Of Medicare Beneficiaries With Drug Services | 201 |
| Total Drug Submitted ChargeAmount | 8920 |
| Total Drug Medicare AllowedAmount | 3967.17 |
| Total Drug Medicare PaymentAmount | 3886.59 |
| Total Drug Medicare Standardized Payment Amount | 3886.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 1845 |
| Number Of Medicare Beneficiaries With Medical Services | 384 |
| Total Medical Submitted Charge Amount | 223954.72 |
| Total Medical Medicare Allowed Amount | 193511.65 |
| Total Medical Medicare Payment Amount | 130436.49 |
| Total Medical Medicare Standardized Payment Amount | 109154.76 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 266 |
| Number Of Male Beneficiaries | 118 |
| Number Of Non Hispanic White Beneficiaries | 37 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 327 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 262 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0602 |