| National Provider Identifier [NPI]: | 1255773248 |
| Last Name Of The Provider | BANZUELO-RIO |
| First Name Of The Provider | MARGIE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5601 LOCH RAVEN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212392945 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 610 |
| Number Of Medicare Beneficiaries | 562 |
| Total Submitted Charge Amount | 147725 |
| Total Medicare Allowed Amount | 104038.61 |
| Total Medicare Payment Amount | 80049.46 |
| Total Medicare Standardized Payment Amount | 78325.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 610 |
| Number Of Medicare Beneficiaries With Medical Services | 562 |
| Total Medical Submitted Charge Amount | 147725 |
| Total Medical Medicare Allowed Amount | 104038.61 |
| Total Medical Medicare Payment Amount | 80049.46 |
| Total Medical Medicare Standardized Payment Amount | 78325.85 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 151 |
| Number Of Beneficiaries Age 75 to 84 | 147 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 316 |
| Number Of Male Beneficiaries | 246 |
| Number Of Non Hispanic White Beneficiaries | 199 |
| Number Of Black or African American Beneficiaries | 352 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 375 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 187 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.6399 |