| National Provider Identifier [NPI]: | 1912169210 |
| Last Name Of The Provider | HERNANDEZ |
| First Name Of The Provider | OMAR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4927 LAKE RIDGE PKWY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | GRAND PRAIRIE |
| Zip Code Of The Provider | 750523087 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1342 |
| Number Of Medicare Beneficiaries | 217 |
| Total Submitted Charge Amount | 94585.87 |
| Total Medicare Allowed Amount | 53589.79 |
| Total Medicare Payment Amount | 36753.85 |
| Total Medicare Standardized Payment Amount | 38051.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 380 |
| Number Of Medicare Beneficiaries With Drug Services | 85 |
| Total Drug Submitted ChargeAmount | 12328.9 |
| Total Drug Medicare AllowedAmount | 5555.34 |
| Total Drug Medicare PaymentAmount | 5010 |
| Total Drug Medicare Standardized Payment Amount | 5010 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 962 |
| Number Of Medicare Beneficiaries With Medical Services | 217 |
| Total Medical Submitted Charge Amount | 82256.97 |
| Total Medical Medicare Allowed Amount | 48034.45 |
| Total Medical Medicare Payment Amount | 31743.85 |
| Total Medical Medicare Standardized Payment Amount | 33041.59 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 99 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 131 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 98 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 72 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 158 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4214 |