| National Provider Identifier [NPI]: | 1467469205 |
| Last Name Of The Provider | NISIMBLAT |
| First Name Of The Provider | ANDRES |
| 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 | 6200 SARATOGA BLVD |
| Street Address 2 Of The Provider | BLDG 5 |
| City Of The Provider | CORPUS CHRISTI |
| Zip Code Of The Provider | 784143477 |
| 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 | 99 |
| Number Of Services | 11792 |
| Number Of Medicare Beneficiaries | 466 |
| Total Submitted Charge Amount | 480603.16 |
| Total Medicare Allowed Amount | 268463.27 |
| Total Medicare Payment Amount | 216398.74 |
| Total Medicare Standardized Payment Amount | 228451.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 550 |
| Number Of Medicare Beneficiaries With Drug Services | 300 |
| Total Drug Submitted ChargeAmount | 26615 |
| Total Drug Medicare AllowedAmount | 14837.75 |
| Total Drug Medicare PaymentAmount | 14125.49 |
| Total Drug Medicare Standardized Payment Amount | 14125.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 88 |
| Number Of Medical Services | 11242 |
| Number Of Medicare Beneficiaries With Medical Services | 466 |
| Total Medical Submitted Charge Amount | 453988.16 |
| Total Medical Medicare Allowed Amount | 253625.52 |
| Total Medical Medicare Payment Amount | 202273.25 |
| Total Medical Medicare Standardized Payment Amount | 214325.55 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 286 |
| Number Of Male Beneficiaries | 180 |
| Number Of Non Hispanic White Beneficiaries | 351 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 100 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 434 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.959 |