| National Provider Identifier [NPI]: | 1639315161 |
| Last Name Of The Provider | SANMIGUEL |
| First Name Of The Provider | GRETCHEN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330 WATERMAN WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAVARES |
| Zip Code Of The Provider | 327785250 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 8107 |
| Number Of Medicare Beneficiaries | 1039 |
| Total Submitted Charge Amount | 810066 |
| Total Medicare Allowed Amount | 341477.58 |
| Total Medicare Payment Amount | 247545.49 |
| Total Medicare Standardized Payment Amount | 250462.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 2830 |
| Number Of Medicare Beneficiaries With Drug Services | 267 |
| Total Drug Submitted ChargeAmount | 97987 |
| Total Drug Medicare AllowedAmount | 35925.18 |
| Total Drug Medicare PaymentAmount | 28554.21 |
| Total Drug Medicare Standardized Payment Amount | 28554.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 5277 |
| Number Of Medicare Beneficiaries With Medical Services | 1039 |
| Total Medical Submitted Charge Amount | 712079 |
| Total Medical Medicare Allowed Amount | 305552.4 |
| Total Medical Medicare Payment Amount | 218991.28 |
| Total Medical Medicare Standardized Payment Amount | 221907.82 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 474 |
| Number Of Beneficiaries Age 75 to 84 | 318 |
| Number Of Beneficiaries Age Greater 84 | 171 |
| Number Of Female Beneficiaries | 662 |
| Number Of Male Beneficiaries | 377 |
| Number Of Non Hispanic White Beneficiaries | 980 |
| Number Of Black or African American Beneficiaries | 19 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 919 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.207 |