| National Provider Identifier [NPI]: | 1649373523 |
| Last Name Of The Provider | BACA |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5162 LINTON BLVD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | DELRAY BEACH |
| Zip Code Of The Provider | 334846567 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 105 |
| Number Of Services | 55303 |
| Number Of Medicare Beneficiaries | 1361 |
| Total Submitted Charge Amount | 1673923.64 |
| Total Medicare Allowed Amount | 1602439.83 |
| Total Medicare Payment Amount | 1253322.84 |
| Total Medicare Standardized Payment Amount | 1227447.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 38250 |
| Number Of Medicare Beneficiaries With Drug Services | 753 |
| Total Drug Submitted ChargeAmount | 977934.2 |
| Total Drug Medicare AllowedAmount | 973531.71 |
| Total Drug Medicare PaymentAmount | 760902.28 |
| Total Drug Medicare Standardized Payment Amount | 760902.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 17053 |
| Number Of Medicare Beneficiaries With Medical Services | 1361 |
| Total Medical Submitted Charge Amount | 695989.44 |
| Total Medical Medicare Allowed Amount | 628908.12 |
| Total Medical Medicare Payment Amount | 492420.56 |
| Total Medical Medicare Standardized Payment Amount | 466545.03 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 400 |
| Number Of Beneficiaries Age 75 to 84 | 552 |
| Number Of Beneficiaries Age Greater 84 | 360 |
| Number Of Female Beneficiaries | 1051 |
| Number Of Male Beneficiaries | 310 |
| Number Of Non Hispanic White Beneficiaries | 1294 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1314 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 43 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4163 |