| National Provider Identifier [NPI]: | 1124128590 |
| Last Name Of The Provider | VASQUEZ |
| First Name Of The Provider | MARIELA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1201 W FRANK |
| Street Address 2 Of The Provider | MEMORIAL MEDICAL CENTER |
| City Of The Provider | LUFKIN |
| Zip Code Of The Provider | 75904 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 2467 |
| Number Of Medicare Beneficiaries | 1149 |
| Total Submitted Charge Amount | 500448.87 |
| Total Medicare Allowed Amount | 79963.42 |
| Total Medicare Payment Amount | 62000.61 |
| Total Medicare Standardized Payment Amount | 51993.22 |
| 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 | 22 |
| Number Of Medical Services | 2467 |
| Number Of Medicare Beneficiaries With Medical Services | 1149 |
| Total Medical Submitted Charge Amount | 500448.87 |
| Total Medical Medicare Allowed Amount | 79963.42 |
| Total Medical Medicare Payment Amount | 62000.61 |
| Total Medical Medicare Standardized Payment Amount | 51993.22 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 202 |
| Number Of Beneficiaries Age 65 to 74 | 484 |
| Number Of Beneficiaries Age 75 to 84 | 342 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 605 |
| Number Of Male Beneficiaries | 544 |
| Number Of Non Hispanic White Beneficiaries | 988 |
| Number Of Black or African American Beneficiaries | 109 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 855 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 294 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6928 |