| National Provider Identifier [NPI]: | 1750359568 |
| Last Name Of The Provider | SARMIENTO |
| First Name Of The Provider | DON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 521 NORTH THOMPSON STREET |
| Street Address 2 Of The Provider | ATTN: MONTGOMERY COUNTY WELLNESS CENTER |
| City Of The Provider | CONROE |
| Zip Code Of The Provider | 773010000 |
| 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 | 34 |
| Number Of Services | 552 |
| Number Of Medicare Beneficiaries | 152 |
| Total Submitted Charge Amount | 50473 |
| Total Medicare Allowed Amount | 19099.04 |
| Total Medicare Payment Amount | 12575.57 |
| Total Medicare Standardized Payment Amount | 12993.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 284 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 1024 |
| Total Drug Medicare AllowedAmount | 53.62 |
| Total Drug Medicare PaymentAmount | 33.29 |
| Total Drug Medicare Standardized Payment Amount | 33.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 268 |
| Number Of Medicare Beneficiaries With Medical Services | 152 |
| Total Medical Submitted Charge Amount | 49449 |
| Total Medical Medicare Allowed Amount | 19045.42 |
| Total Medical Medicare Payment Amount | 12542.28 |
| Total Medical Medicare Standardized Payment Amount | 12960.53 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 73 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 56 |
| Number Of Non Hispanic White Beneficiaries | 128 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 133 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0374 |