| National Provider Identifier [NPI]: | 1972564953 |
| Last Name Of The Provider | MONTICCIOLO |
| First Name Of The Provider | DEBRA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2401 S 31ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEMPLE |
| Zip Code Of The Provider | 765080001 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 4279 |
| Number Of Medicare Beneficiaries | 2104 |
| Total Submitted Charge Amount | 327907 |
| Total Medicare Allowed Amount | 95243.74 |
| Total Medicare Payment Amount | 83287.61 |
| Total Medicare Standardized Payment Amount | 86272.61 |
| 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 | 49 |
| Number Of Medical Services | 4279 |
| Number Of Medicare Beneficiaries With Medical Services | 2104 |
| Total Medical Submitted Charge Amount | 327907 |
| Total Medical Medicare Allowed Amount | 95243.74 |
| Total Medical Medicare Payment Amount | 83287.61 |
| Total Medical Medicare Standardized Payment Amount | 86272.61 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 413 |
| Number Of Beneficiaries Age 65 to 74 | 1082 |
| Number Of Beneficiaries Age 75 to 84 | 506 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 1945 |
| Number Of Male Beneficiaries | 159 |
| Number Of Non Hispanic White Beneficiaries | 1536 |
| Number Of Black or African American Beneficiaries | 305 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 198 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1691 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 413 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0894 |