| National Provider Identifier [NPI]: | 1477664852 |
| Last Name Of The Provider | ANDRES |
| First Name Of The Provider | BLANCA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 604 ROSE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | VENICE |
| Zip Code Of The Provider | 902912767 |
| 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 | 16 |
| Number Of Services | 421 |
| Number Of Medicare Beneficiaries | 90 |
| Total Submitted Charge Amount | 40710.83 |
| Total Medicare Allowed Amount | 20415.51 |
| Total Medicare Payment Amount | 12977.87 |
| Total Medicare Standardized Payment Amount | 12005.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 732.79 |
| Total Drug Medicare AllowedAmount | 153.4 |
| Total Drug Medicare PaymentAmount | 150.35 |
| Total Drug Medicare Standardized Payment Amount | 150.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 410 |
| Number Of Medicare Beneficiaries With Medical Services | 90 |
| Total Medical Submitted Charge Amount | 39978.04 |
| Total Medical Medicare Allowed Amount | 20262.11 |
| Total Medical Medicare Payment Amount | 12827.52 |
| Total Medical Medicare Standardized Payment Amount | 11854.94 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 63 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 16 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| 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 | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.021 |