| National Provider Identifier [NPI]: | 1851366785 |
| Last Name Of The Provider | FRED-MIRANDA |
| First Name Of The Provider | ILIANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5131 MEDICAL DR |
| Street Address 2 Of The Provider | STE 120 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295062 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 4004 |
| Number Of Medicare Beneficiaries | 743 |
| Total Submitted Charge Amount | 446780.9 |
| Total Medicare Allowed Amount | 357961.2 |
| Total Medicare Payment Amount | 268827.09 |
| Total Medicare Standardized Payment Amount | 280387.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 948 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 23596 |
| Total Drug Medicare AllowedAmount | 11052.16 |
| Total Drug Medicare PaymentAmount | 8588.81 |
| Total Drug Medicare Standardized Payment Amount | 8588.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 3056 |
| Number Of Medicare Beneficiaries With Medical Services | 743 |
| Total Medical Submitted Charge Amount | 423184.9 |
| Total Medical Medicare Allowed Amount | 346909.04 |
| Total Medical Medicare Payment Amount | 260238.28 |
| Total Medical Medicare Standardized Payment Amount | 271798.75 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 180 |
| Number Of Beneficiaries Age 65 to 74 | 246 |
| Number Of Beneficiaries Age 75 to 84 | 214 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 402 |
| Number Of Male Beneficiaries | 341 |
| Number Of Non Hispanic White Beneficiaries | 347 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 312 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 559 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 184 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 67 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 3.9099 |