| National Provider Identifier [NPI]: | 1881699361 |
| Last Name Of The Provider | BALLESTEROS |
| First Name Of The Provider | MARIA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11130 CHRISTUS HILLS |
| Street Address 2 Of The Provider | 3RD FLOOR |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782513584 |
| 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 | 64 |
| Number Of Services | 606 |
| Number Of Medicare Beneficiaries | 199 |
| Total Submitted Charge Amount | 65341.38 |
| Total Medicare Allowed Amount | 44191.63 |
| Total Medicare Payment Amount | 31708.12 |
| Total Medicare Standardized Payment Amount | 33893.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 58 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 1436.62 |
| Total Drug Medicare AllowedAmount | 874.47 |
| Total Drug Medicare PaymentAmount | 821.68 |
| Total Drug Medicare Standardized Payment Amount | 821.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 548 |
| Number Of Medicare Beneficiaries With Medical Services | 199 |
| Total Medical Submitted Charge Amount | 63904.76 |
| Total Medical Medicare Allowed Amount | 43317.16 |
| Total Medical Medicare Payment Amount | 30886.44 |
| Total Medical Medicare Standardized Payment Amount | 33071.33 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 124 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 79 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 127 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7145 |