| National Provider Identifier [NPI]: | 1508980327 |
| Last Name Of The Provider | DEAN |
| First Name Of The Provider | LARA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8401 DATAPOINT DR |
| Street Address 2 Of The Provider | SUITE 500 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295900 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 1234 |
| Number Of Medicare Beneficiaries | 711 |
| Total Submitted Charge Amount | 569471.04 |
| Total Medicare Allowed Amount | 123707.83 |
| Total Medicare Payment Amount | 95252.96 |
| Total Medicare Standardized Payment Amount | 97996.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 1234 |
| Number Of Medicare Beneficiaries With Medical Services | 711 |
| Total Medical Submitted Charge Amount | 569471.04 |
| Total Medical Medicare Allowed Amount | 123707.83 |
| Total Medical Medicare Payment Amount | 95252.96 |
| Total Medical Medicare Standardized Payment Amount | 97996.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 207 |
| Number Of Beneficiaries Age 65 to 74 | 199 |
| Number Of Beneficiaries Age 75 to 84 | 169 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 434 |
| Number Of Male Beneficiaries | 277 |
| Number Of Non Hispanic White Beneficiaries | 301 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 303 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 366 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 345 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.6217 |