| National Provider Identifier [NPI]: | 1477682045 |
| Last Name Of The Provider | FAJARDO |
| First Name Of The Provider | REBECA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7035 1ST AVE S |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST PETERSBURG |
| Zip Code Of The Provider | 337071203 |
| 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 | 30 |
| Number Of Services | 561 |
| Number Of Medicare Beneficiaries | 134 |
| Total Submitted Charge Amount | 81844 |
| Total Medicare Allowed Amount | 39984.26 |
| Total Medicare Payment Amount | 28401.84 |
| Total Medicare Standardized Payment Amount | 28219.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 830 |
| Total Drug Medicare AllowedAmount | 177.89 |
| Total Drug Medicare PaymentAmount | 150.3 |
| Total Drug Medicare Standardized Payment Amount | 150.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 540 |
| Number Of Medicare Beneficiaries With Medical Services | 134 |
| Total Medical Submitted Charge Amount | 81014 |
| Total Medical Medicare Allowed Amount | 39806.37 |
| Total Medical Medicare Payment Amount | 28251.54 |
| Total Medical Medicare Standardized Payment Amount | 28069.62 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 36 |
| Number Of Beneficiaries Age 65 to 74 | 49 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 77 |
| Number Of Male Beneficiaries | 57 |
| Number Of Non Hispanic White Beneficiaries | 63 |
| 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 | 47 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 87 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2741 |