| National Provider Identifier [NPI]: | 1548216443 |
| Last Name Of The Provider | BERTOLDO |
| First Name Of The Provider | FRED |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1619 N GREENWOOD ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810032644 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 214 |
| Number Of Services | 7330 |
| Number Of Medicare Beneficiaries | 3849 |
| Total Submitted Charge Amount | 1572664 |
| Total Medicare Allowed Amount | 328899.12 |
| Total Medicare Payment Amount | 249557.64 |
| Total Medicare Standardized Payment Amount | 250426.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 670 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 6980 |
| Total Drug Medicare AllowedAmount | 914.27 |
| Total Drug Medicare PaymentAmount | 716.68 |
| Total Drug Medicare Standardized Payment Amount | 716.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 209 |
| Number Of Medical Services | 6660 |
| Number Of Medicare Beneficiaries With Medical Services | 3849 |
| Total Medical Submitted Charge Amount | 1565684 |
| Total Medical Medicare Allowed Amount | 327984.85 |
| Total Medical Medicare Payment Amount | 248840.96 |
| Total Medical Medicare Standardized Payment Amount | 249709.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 881 |
| Number Of Beneficiaries Age 65 to 74 | 1341 |
| Number Of Beneficiaries Age 75 to 84 | 1078 |
| Number Of Beneficiaries Age Greater 84 | 549 |
| Number Of Female Beneficiaries | 2252 |
| Number Of Male Beneficiaries | 1597 |
| Number Of Non Hispanic White Beneficiaries | 2743 |
| Number Of Black or African American Beneficiaries | 60 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 994 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2716 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1133 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5681 |