| National Provider Identifier [NPI]: | 1821148917 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | LUIS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330N 2ND ST 400 |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850122371 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 948 |
| Number Of Medicare Beneficiaries | 131 |
| Total Submitted Charge Amount | 91781.79 |
| Total Medicare Allowed Amount | 79078.05 |
| Total Medicare Payment Amount | 59348.58 |
| Total Medicare Standardized Payment Amount | 57362.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 94 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 2060 |
| Total Drug Medicare AllowedAmount | 694.81 |
| Total Drug Medicare PaymentAmount | 654.25 |
| Total Drug Medicare Standardized Payment Amount | 654.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 854 |
| Number Of Medicare Beneficiaries With Medical Services | 131 |
| Total Medical Submitted Charge Amount | 89721.79 |
| Total Medical Medicare Allowed Amount | 78383.24 |
| Total Medical Medicare Payment Amount | 58694.33 |
| Total Medical Medicare Standardized Payment Amount | 56708.12 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 42 |
| Number Of Beneficiaries Age 65 to 74 | 51 |
| Number Of Beneficiaries Age 75 to 84 | 27 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 66 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 103 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 41 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4815 |