| National Provider Identifier [NPI]: | 1861440950 |
| Last Name Of The Provider | LOPEZ-LAGO |
| First Name Of The Provider | JOSE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1015 MEDICAL CENTER PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | SELMA |
| Zip Code Of The Provider | 367016748 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 875 |
| Number Of Medicare Beneficiaries | 688 |
| Total Submitted Charge Amount | 378888 |
| Total Medicare Allowed Amount | 98508.62 |
| Total Medicare Payment Amount | 69648.91 |
| Total Medicare Standardized Payment Amount | 74083.42 |
| 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 | 10 |
| Number Of Medical Services | 875 |
| Number Of Medicare Beneficiaries With Medical Services | 688 |
| Total Medical Submitted Charge Amount | 378888 |
| Total Medical Medicare Allowed Amount | 98508.62 |
| Total Medical Medicare Payment Amount | 69648.91 |
| Total Medical Medicare Standardized Payment Amount | 74083.42 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 214 |
| Number Of Beneficiaries Age 65 to 74 | 194 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 406 |
| Number Of Male Beneficiaries | 282 |
| Number Of Non Hispanic White Beneficiaries | 413 |
| 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 | 417 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 271 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.5438 |