| National Provider Identifier [NPI]: | 1245342781 |
| Last Name Of The Provider | ERFE |
| First Name Of The Provider | DOLORES |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | HIGHWAY 171 WEST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEXIA |
| Zip Code Of The Provider | 76667 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 1070 |
| Number Of Medicare Beneficiaries | 124 |
| Total Submitted Charge Amount | 37188.18 |
| Total Medicare Allowed Amount | 35788.52 |
| Total Medicare Payment Amount | 27989.13 |
| Total Medicare Standardized Payment Amount | 28887.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 105 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 1340.67 |
| Total Drug Medicare AllowedAmount | 1283.58 |
| Total Drug Medicare PaymentAmount | 1035.52 |
| Total Drug Medicare Standardized Payment Amount | 1035.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 965 |
| Number Of Medicare Beneficiaries With Medical Services | 124 |
| Total Medical Submitted Charge Amount | 35847.51 |
| Total Medical Medicare Allowed Amount | 34504.94 |
| Total Medical Medicare Payment Amount | 26953.61 |
| Total Medical Medicare Standardized Payment Amount | 27851.97 |
| Average Age Of Beneficiaries | 57 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 58 |
| Number Of Male Beneficiaries | 66 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 0 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 124 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 11 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 20 |
| Percent Of With Ischemic Heart Disease | 9 |
| Percent Of With Osteoporosis | 44 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.6994 |