| National Provider Identifier [NPI]: | 1851385272 |
| Last Name Of The Provider | GUILLERMO |
| First Name Of The Provider | BENJAMIN |
| 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 | 250 BLOSSOM ST |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | WEBSTER |
| Zip Code Of The Provider | 775984204 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 1924 |
| Number Of Medicare Beneficiaries | 198 |
| Total Submitted Charge Amount | 159125.35 |
| Total Medicare Allowed Amount | 72751.89 |
| Total Medicare Payment Amount | 52651.08 |
| Total Medicare Standardized Payment Amount | 53123.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 390 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 18383.44 |
| Total Drug Medicare AllowedAmount | 5626.12 |
| Total Drug Medicare PaymentAmount | 4699.73 |
| Total Drug Medicare Standardized Payment Amount | 4699.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 1534 |
| Number Of Medicare Beneficiaries With Medical Services | 198 |
| Total Medical Submitted Charge Amount | 140741.91 |
| Total Medical Medicare Allowed Amount | 67125.77 |
| Total Medical Medicare Payment Amount | 47951.35 |
| Total Medical Medicare Standardized Payment Amount | 48423.95 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 114 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 67 |
| Number Of Male Beneficiaries | 131 |
| Number Of Non Hispanic White Beneficiaries | 130 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 173 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.0017 |