| National Provider Identifier [NPI]: | 1114917424 |
| Last Name Of The Provider | DOMINGUEZ |
| First Name Of The Provider | LEONARDO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 4TH ST |
| Street Address 2 Of The Provider | 2A100 |
| City Of The Provider | LUBBOCK |
| Zip Code Of The Provider | 794300002 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 2975 |
| Number Of Medicare Beneficiaries | 416 |
| Total Submitted Charge Amount | 723407.95 |
| Total Medicare Allowed Amount | 296929.48 |
| Total Medicare Payment Amount | 220729.16 |
| Total Medicare Standardized Payment Amount | 235485.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 865 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 54712.95 |
| Total Drug Medicare AllowedAmount | 40592.96 |
| Total Drug Medicare PaymentAmount | 31162.37 |
| Total Drug Medicare Standardized Payment Amount | 31162.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 2110 |
| Number Of Medicare Beneficiaries With Medical Services | 416 |
| Total Medical Submitted Charge Amount | 668695 |
| Total Medical Medicare Allowed Amount | 256336.52 |
| Total Medical Medicare Payment Amount | 189566.79 |
| Total Medical Medicare Standardized Payment Amount | 204323.25 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 139 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 241 |
| Number Of Male Beneficiaries | 175 |
| Number Of Non Hispanic White Beneficiaries | 261 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 137 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 317 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8494 |