| National Provider Identifier [NPI]: | 1609841121 |
| Last Name Of The Provider | ZEPEDA |
| First Name Of The Provider | LAURA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 GRAND BLVD |
| Street Address 2 Of The Provider | GALERIA PASEOS MALL SUITE 106-A |
| City Of The Provider | SAN JUAN |
| Zip Code Of The Provider | 009265955 |
| State Code Of The Provider | PR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 100 |
| Number Of Medicare Beneficiaries | 51 |
| Total Submitted Charge Amount | 5287.64 |
| Total Medicare Allowed Amount | 5062.26 |
| Total Medicare Payment Amount | 3158.65 |
| Total Medicare Standardized Payment Amount | 4260.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 404.73 |
| Total Drug Medicare AllowedAmount | 179.87 |
| Total Drug Medicare PaymentAmount | 176.29 |
| Total Drug Medicare Standardized Payment Amount | 176.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 87 |
| Number Of Medicare Beneficiaries With Medical Services | 50 |
| Total Medical Submitted Charge Amount | 4882.91 |
| Total Medical Medicare Allowed Amount | 4882.39 |
| Total Medical Medicare Payment Amount | 2982.36 |
| Total Medical Medicare Standardized Payment Amount | 4083.73 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 31 |
| Number Of Male Beneficiaries | 20 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 27 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.015 |