| National Provider Identifier [NPI]: | 1578639621 |
| Last Name Of The Provider | LARA |
| First Name Of The Provider | SERGIO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2606 YONKERS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PLAINVIEW |
| Zip Code Of The Provider | 790721851 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 4046 |
| Number Of Medicare Beneficiaries | 661 |
| Total Submitted Charge Amount | 394819.5 |
| Total Medicare Allowed Amount | 211135.68 |
| Total Medicare Payment Amount | 164689.08 |
| Total Medicare Standardized Payment Amount | 168984.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 1045 |
| Number Of Medicare Beneficiaries With Drug Services | 293 |
| Total Drug Submitted ChargeAmount | 23917 |
| Total Drug Medicare AllowedAmount | 4883.09 |
| Total Drug Medicare PaymentAmount | 4562.61 |
| Total Drug Medicare Standardized Payment Amount | 4562.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 3001 |
| Number Of Medicare Beneficiaries With Medical Services | 661 |
| Total Medical Submitted Charge Amount | 370902.5 |
| Total Medical Medicare Allowed Amount | 206252.59 |
| Total Medical Medicare Payment Amount | 160126.47 |
| Total Medical Medicare Standardized Payment Amount | 164421.72 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 231 |
| Number Of Beneficiaries Age 75 to 84 | 246 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 258 |
| Number Of Non Hispanic White Beneficiaries | 338 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 291 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 449 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 212 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1806 |