| National Provider Identifier [NPI]: | 1194836825 |
| Last Name Of The Provider | GONZALEZ-MENDOZA |
| First Name Of The Provider | MARIEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2485 PINELLAS PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | THE VILLAGES |
| Zip Code Of The Provider | 321632703 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 5031 |
| Number Of Medicare Beneficiaries | 600 |
| Total Submitted Charge Amount | 307714.23 |
| Total Medicare Allowed Amount | 178056.24 |
| Total Medicare Payment Amount | 135245.06 |
| Total Medicare Standardized Payment Amount | 135595.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 580 |
| Number Of Medicare Beneficiaries With Drug Services | 192 |
| Total Drug Submitted ChargeAmount | 16056 |
| Total Drug Medicare AllowedAmount | 11568.79 |
| Total Drug Medicare PaymentAmount | 10418.25 |
| Total Drug Medicare Standardized Payment Amount | 10418.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 4451 |
| Number Of Medicare Beneficiaries With Medical Services | 600 |
| Total Medical Submitted Charge Amount | 291658.23 |
| Total Medical Medicare Allowed Amount | 166487.45 |
| Total Medical Medicare Payment Amount | 124826.81 |
| Total Medical Medicare Standardized Payment Amount | 125177.24 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 479 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 423 |
| Number Of Male Beneficiaries | 177 |
| Number Of Non Hispanic White Beneficiaries | 575 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 5 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.7052 |