| National Provider Identifier [NPI]: | 1245246180 |
| Last Name Of The Provider | LONGORIA |
| First Name Of The Provider | TARA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3911 AVENUE B |
| Street Address 2 Of The Provider | SUITE 1100 |
| City Of The Provider | SCOTTSBLUFF |
| Zip Code Of The Provider | 693614617 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 4756 |
| Number Of Medicare Beneficiaries | 727 |
| Total Submitted Charge Amount | 353366.61 |
| Total Medicare Allowed Amount | 188129.39 |
| Total Medicare Payment Amount | 129695.43 |
| Total Medicare Standardized Payment Amount | 144158.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 619 |
| Number Of Medicare Beneficiaries With Drug Services | 166 |
| Total Drug Submitted ChargeAmount | 14874 |
| Total Drug Medicare AllowedAmount | 7319.37 |
| Total Drug Medicare PaymentAmount | 5995.65 |
| Total Drug Medicare Standardized Payment Amount | 5995.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 4137 |
| Number Of Medicare Beneficiaries With Medical Services | 727 |
| Total Medical Submitted Charge Amount | 338492.61 |
| Total Medical Medicare Allowed Amount | 180810.02 |
| Total Medical Medicare Payment Amount | 123699.78 |
| Total Medical Medicare Standardized Payment Amount | 138162.81 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 90 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 218 |
| Number Of Beneficiaries Age Greater 84 | 157 |
| Number Of Female Beneficiaries | 512 |
| Number Of Male Beneficiaries | 215 |
| Number Of Non Hispanic White Beneficiaries | 618 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 84 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 572 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 155 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0368 |