| National Provider Identifier [NPI]: | 1093896144 |
| Last Name Of The Provider | BONG |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6071 E WOODMEN RD |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | COLORADO SPRINGS |
| Zip Code Of The Provider | 809232607 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 1912 |
| Number Of Medicare Beneficiaries | 396 |
| Total Submitted Charge Amount | 281814.79 |
| Total Medicare Allowed Amount | 148402.22 |
| Total Medicare Payment Amount | 110301.99 |
| Total Medicare Standardized Payment Amount | 110191.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 321 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 16728.6 |
| Total Drug Medicare AllowedAmount | 8409.24 |
| Total Drug Medicare PaymentAmount | 6406.11 |
| Total Drug Medicare Standardized Payment Amount | 6406.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 1591 |
| Number Of Medicare Beneficiaries With Medical Services | 396 |
| Total Medical Submitted Charge Amount | 265086.19 |
| Total Medical Medicare Allowed Amount | 139992.98 |
| Total Medical Medicare Payment Amount | 103895.88 |
| Total Medical Medicare Standardized Payment Amount | 103785.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 210 |
| Number Of Beneficiaries Age 75 to 84 | 130 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 116 |
| Number Of Male Beneficiaries | 280 |
| Number Of Non Hispanic White Beneficiaries | 344 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 369 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0342 |