| National Provider Identifier [NPI]: | 1215028238 |
| Last Name Of The Provider | JORGE |
| First Name Of The Provider | CAMILO |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16415 COLORADO AVE |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | PARAMOUNT |
| Zip Code Of The Provider | 907235035 |
| 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 | 13 |
| Number Of Services | 796 |
| Number Of Medicare Beneficiaries | 168 |
| Total Submitted Charge Amount | 49925.68 |
| Total Medicare Allowed Amount | 49225.75 |
| Total Medicare Payment Amount | 33144.04 |
| Total Medicare Standardized Payment Amount | 33515.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 81 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 1509.91 |
| Total Drug Medicare AllowedAmount | 938.51 |
| Total Drug Medicare PaymentAmount | 904.28 |
| Total Drug Medicare Standardized Payment Amount | 904.28 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 715 |
| Number Of Medicare Beneficiaries With Medical Services | 168 |
| Total Medical Submitted Charge Amount | 48415.77 |
| Total Medical Medicare Allowed Amount | 48287.24 |
| Total Medical Medicare Payment Amount | 32239.76 |
| Total Medical Medicare Standardized Payment Amount | 32611.63 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 55 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 36 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2215 |