| National Provider Identifier [NPI]: | 1750564480 |
| Last Name Of The Provider | COLE-PEREZ |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5920 SARATOGA BLVD |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784144103 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 3459 |
| Number Of Medicare Beneficiaries | 581 |
| Total Submitted Charge Amount | 315991 |
| Total Medicare Allowed Amount | 123998.94 |
| Total Medicare Payment Amount | 86197.49 |
| Total Medicare Standardized Payment Amount | 88942.08 |
| 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 | 28 |
| Number Of Medical Services | 3459 |
| Number Of Medicare Beneficiaries With Medical Services | 581 |
| Total Medical Submitted Charge Amount | 315991 |
| Total Medical Medicare Allowed Amount | 123998.94 |
| Total Medical Medicare Payment Amount | 86197.49 |
| Total Medical Medicare Standardized Payment Amount | 88942.08 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 279 |
| Number Of Beneficiaries Age 75 to 84 | 194 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 269 |
| Number Of Non Hispanic White Beneficiaries | 542 |
| 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 | 568 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9391 |