| National Provider Identifier [NPI]: | 1306072004 |
| Last Name Of The Provider | HENRIQUEZ |
| First Name Of The Provider | OMAR |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4513 EXECUTIVE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341199033 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 12496 |
| Number Of Medicare Beneficiaries | 241 |
| Total Submitted Charge Amount | 493092.02 |
| Total Medicare Allowed Amount | 304831.11 |
| Total Medicare Payment Amount | 258541.21 |
| Total Medicare Standardized Payment Amount | 210155.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 6036 |
| Number Of Medicare Beneficiaries With Drug Services | 162 |
| Total Drug Submitted ChargeAmount | 46102.67 |
| Total Drug Medicare AllowedAmount | 7425.45 |
| Total Drug Medicare PaymentAmount | 5809.65 |
| Total Drug Medicare Standardized Payment Amount | 5809.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 6460 |
| Number Of Medicare Beneficiaries With Medical Services | 241 |
| Total Medical Submitted Charge Amount | 446989.35 |
| Total Medical Medicare Allowed Amount | 297405.66 |
| Total Medical Medicare Payment Amount | 252731.56 |
| Total Medical Medicare Standardized Payment Amount | 204345.64 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 111 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 95 |
| Number Of Non Hispanic White Beneficiaries | 222 |
| 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 | 197 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 44 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3821 |