| National Provider Identifier [NPI]: | 1043217763 |
| Last Name Of The Provider | HERNANDEZ |
| First Name Of The Provider | TERESA |
| 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 | 1182 OCEAN SHORE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORMOND BEACH |
| Zip Code Of The Provider | 321763799 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 896 |
| Number Of Medicare Beneficiaries | 153 |
| Total Submitted Charge Amount | 84470.4 |
| Total Medicare Allowed Amount | 59980.12 |
| Total Medicare Payment Amount | 46511.26 |
| Total Medicare Standardized Payment Amount | 47031.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 5737.96 |
| Total Drug Medicare AllowedAmount | 4117.1 |
| Total Drug Medicare PaymentAmount | 3920.61 |
| Total Drug Medicare Standardized Payment Amount | 3920.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 781 |
| Number Of Medicare Beneficiaries With Medical Services | 153 |
| Total Medical Submitted Charge Amount | 78732.44 |
| Total Medical Medicare Allowed Amount | 55863.02 |
| Total Medical Medicare Payment Amount | 42590.65 |
| Total Medical Medicare Standardized Payment Amount | 43110.55 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 36 |
| Number Of Non Hispanic White Beneficiaries | 135 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 0.8194 |