| National Provider Identifier [NPI]: | 1932177177 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | RAPHAEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 131 WEBB DR |
| Street Address 2 Of The Provider | SUITE C |
| City Of The Provider | DAVENPORT |
| Zip Code Of The Provider | 338373921 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 4098 |
| Number Of Medicare Beneficiaries | 495 |
| Total Submitted Charge Amount | 605458.85 |
| Total Medicare Allowed Amount | 307055.37 |
| Total Medicare Payment Amount | 218656.78 |
| Total Medicare Standardized Payment Amount | 224405.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 223 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 5013 |
| Total Drug Medicare AllowedAmount | 481.73 |
| Total Drug Medicare PaymentAmount | 367.87 |
| Total Drug Medicare Standardized Payment Amount | 367.87 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 84 |
| Number Of Medical Services | 3875 |
| Number Of Medicare Beneficiaries With Medical Services | 495 |
| Total Medical Submitted Charge Amount | 600445.85 |
| Total Medical Medicare Allowed Amount | 306573.64 |
| Total Medical Medicare Payment Amount | 218288.91 |
| Total Medical Medicare Standardized Payment Amount | 224037.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 238 |
| Number Of Beneficiaries Age 75 to 84 | 148 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 259 |
| Number Of Male Beneficiaries | 236 |
| Number Of Non Hispanic White Beneficiaries | 435 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 425 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 70 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4099 |