| National Provider Identifier [NPI]: | 1821055427 |
| Last Name Of The Provider | MEDINA |
| First Name Of The Provider | NUBIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 90 HIGHLAND AVE |
| Street Address 2 Of The Provider | VHC SAN MARTIN FAMILY PRACTICE CLINIC |
| City Of The Provider | SAN MARTIN |
| Zip Code Of The Provider | 950469504 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 239 |
| Number Of Medicare Beneficiaries | 109 |
| Total Submitted Charge Amount | 54059.93 |
| Total Medicare Allowed Amount | 13557.43 |
| Total Medicare Payment Amount | 10437.29 |
| Total Medicare Standardized Payment Amount | 8342.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 1759.32 |
| Total Drug Medicare AllowedAmount | 748.89 |
| Total Drug Medicare PaymentAmount | 733.88 |
| Total Drug Medicare Standardized Payment Amount | 733.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 206 |
| Number Of Medicare Beneficiaries With Medical Services | 109 |
| Total Medical Submitted Charge Amount | 52300.61 |
| Total Medical Medicare Allowed Amount | 12808.54 |
| Total Medical Medicare Payment Amount | 9703.41 |
| Total Medical Medicare Standardized Payment Amount | 7608.15 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 31 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 75 |
| Number Of Male Beneficiaries | 34 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 76 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 20 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 89 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2098 |