| National Provider Identifier [NPI]: | 1396939575 |
| Last Name Of The Provider | AVILA |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1510 SAN PABLO ST |
| Street Address 2 Of The Provider | 6TH FLOOR |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900335320 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 371 |
| Number Of Medicare Beneficiaries | 145 |
| Total Submitted Charge Amount | 55389.71 |
| Total Medicare Allowed Amount | 27930.58 |
| Total Medicare Payment Amount | 20195.95 |
| Total Medicare Standardized Payment Amount | 18810.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 1524.2 |
| Total Drug Medicare AllowedAmount | 735.92 |
| Total Drug Medicare PaymentAmount | 721.16 |
| Total Drug Medicare Standardized Payment Amount | 721.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 351 |
| Number Of Medicare Beneficiaries With Medical Services | 145 |
| Total Medical Submitted Charge Amount | 53865.51 |
| Total Medical Medicare Allowed Amount | 27194.66 |
| Total Medical Medicare Payment Amount | 19474.79 |
| Total Medical Medicare Standardized Payment Amount | 18089.23 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 58 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 97 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 51 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 72 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 25 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5157 |