| National Provider Identifier [NPI]: | 1710990882 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | MARIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3340 TAMIAMI TRL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339528088 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 13602 |
| Number Of Medicare Beneficiaries | 2100 |
| Total Submitted Charge Amount | 1249312.49 |
| Total Medicare Allowed Amount | 1165590.66 |
| Total Medicare Payment Amount | 886406.73 |
| Total Medicare Standardized Payment Amount | 899394.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 5329 |
| Number Of Medicare Beneficiaries With Drug Services | 169 |
| Total Drug Submitted ChargeAmount | 30997.98 |
| Total Drug Medicare AllowedAmount | 30714.09 |
| Total Drug Medicare PaymentAmount | 24079.63 |
| Total Drug Medicare Standardized Payment Amount | 24079.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 99 |
| Number Of Medical Services | 8273 |
| Number Of Medicare Beneficiaries With Medical Services | 2100 |
| Total Medical Submitted Charge Amount | 1218314.51 |
| Total Medical Medicare Allowed Amount | 1134876.57 |
| Total Medical Medicare Payment Amount | 862327.1 |
| Total Medical Medicare Standardized Payment Amount | 875314.66 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 94 |
| Number Of Beneficiaries Age 65 to 74 | 721 |
| Number Of Beneficiaries Age 75 to 84 | 837 |
| Number Of Beneficiaries Age Greater 84 | 448 |
| Number Of Female Beneficiaries | 933 |
| Number Of Male Beneficiaries | 1167 |
| Number Of Non Hispanic White Beneficiaries | 1959 |
| Number Of Black or African American Beneficiaries | 50 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1904 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 196 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.652 |