| National Provider Identifier [NPI]: | 1275572372 |
| Last Name Of The Provider | BALLESTEROS |
| First Name Of The Provider | DOUGLAS |
| 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 | 2400 E 4TH ST |
| Street Address 2 Of The Provider | EMERGENCY DEPARTMENT |
| City Of The Provider | NATIONAL CITY |
| Zip Code Of The Provider | 919502026 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1206 |
| Number Of Medicare Beneficiaries | 737 |
| Total Submitted Charge Amount | 491754 |
| Total Medicare Allowed Amount | 123554.64 |
| Total Medicare Payment Amount | 93113.14 |
| Total Medicare Standardized Payment Amount | 92008.4 |
| 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 | 41 |
| Number Of Medical Services | 1206 |
| Number Of Medicare Beneficiaries With Medical Services | 737 |
| Total Medical Submitted Charge Amount | 491754 |
| Total Medical Medicare Allowed Amount | 123554.64 |
| Total Medical Medicare Payment Amount | 93113.14 |
| Total Medical Medicare Standardized Payment Amount | 92008.4 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 279 |
| Number Of Beneficiaries Age 65 to 74 | 174 |
| Number Of Beneficiaries Age 75 to 84 | 167 |
| Number Of Beneficiaries Age Greater 84 | 117 |
| Number Of Female Beneficiaries | 384 |
| Number Of Male Beneficiaries | 353 |
| Number Of Non Hispanic White Beneficiaries | 241 |
| Number Of Black or African American Beneficiaries | 84 |
| Number Of AsianPacific Islander Beneficiaries | 72 |
| Number Of Hispanic Beneficiaries | 329 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 181 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 556 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 30 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.7086 |