| National Provider Identifier [NPI]: | 1134433113 |
| Last Name Of The Provider | MBOLA |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | ANP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8511 S SAM HOUSTON PKWY E |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770754874 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 2448 |
| Number Of Medicare Beneficiaries | 400 |
| Total Submitted Charge Amount | 377242.39 |
| Total Medicare Allowed Amount | 213610.68 |
| Total Medicare Payment Amount | 154611.56 |
| Total Medicare Standardized Payment Amount | 188904.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 2448 |
| Number Of Medicare Beneficiaries With Medical Services | 400 |
| Total Medical Submitted Charge Amount | 377242.39 |
| Total Medical Medicare Allowed Amount | 213610.68 |
| Total Medical Medicare Payment Amount | 154611.56 |
| Total Medical Medicare Standardized Payment Amount | 188904.94 |
| Average Age Of Beneficiaries | 82 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 276 |
| Number Of Male Beneficiaries | 124 |
| Number Of Non Hispanic White Beneficiaries | 262 |
| Number Of Black or African American Beneficiaries | 83 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 229 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 171 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 56 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 50 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 27 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.6152 |