| National Provider Identifier [NPI]: | 1629088810 |
| Last Name Of The Provider | HERNANDEZ |
| First Name Of The Provider | MANUEL |
| 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 | 601 E ROLLINS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORLANDO |
| Zip Code Of The Provider | 328031248 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 15688 |
| Number Of Medicare Beneficiaries | 2318 |
| Total Submitted Charge Amount | 721955.14 |
| Total Medicare Allowed Amount | 236625.61 |
| Total Medicare Payment Amount | 179551.31 |
| Total Medicare Standardized Payment Amount | 184048.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 12917 |
| Number Of Medicare Beneficiaries With Drug Services | 107 |
| Total Drug Submitted ChargeAmount | 6638.54 |
| Total Drug Medicare AllowedAmount | 3261.03 |
| Total Drug Medicare PaymentAmount | 2501.92 |
| Total Drug Medicare Standardized Payment Amount | 2501.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 2771 |
| Number Of Medicare Beneficiaries With Medical Services | 2308 |
| Total Medical Submitted Charge Amount | 715316.6 |
| Total Medical Medicare Allowed Amount | 233364.58 |
| Total Medical Medicare Payment Amount | 177049.39 |
| Total Medical Medicare Standardized Payment Amount | 181546.79 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 470 |
| Number Of Beneficiaries Age 65 to 74 | 843 |
| Number Of Beneficiaries Age 75 to 84 | 652 |
| Number Of Beneficiaries Age Greater 84 | 353 |
| Number Of Female Beneficiaries | 1299 |
| Number Of Male Beneficiaries | 1019 |
| Number Of Non Hispanic White Beneficiaries | 1621 |
| Number Of Black or African American Beneficiaries | 250 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 385 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1699 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 619 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.1707 |