| National Provider Identifier [NPI]: | 1598845885 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | HUMBERTO |
| 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 | 10 MEDICAL PKWY |
| Street Address 2 Of The Provider | PLAZA 3 SUITE 208 |
| City Of The Provider | FARMERS BRANCH |
| Zip Code Of The Provider | 752347840 |
| 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 | 19 |
| Number Of Services | 355 |
| Number Of Medicare Beneficiaries | 50 |
| Total Submitted Charge Amount | 45567 |
| Total Medicare Allowed Amount | 17915.86 |
| Total Medicare Payment Amount | 10406.85 |
| Total Medicare Standardized Payment Amount | 10341.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 687 |
| Total Drug Medicare AllowedAmount | 46.12 |
| Total Drug Medicare PaymentAmount | 18.65 |
| Total Drug Medicare Standardized Payment Amount | 18.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 323 |
| Number Of Medicare Beneficiaries With Medical Services | 50 |
| Total Medical Submitted Charge Amount | 44880 |
| Total Medical Medicare Allowed Amount | 17869.74 |
| Total Medical Medicare Payment Amount | 10388.2 |
| Total Medical Medicare Standardized Payment Amount | 10322.87 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 25 |
| Number Of Male Beneficiaries | 25 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 25 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| 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 | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.2764 |