| National Provider Identifier [NPI]: | 1972546109 |
| Last Name Of The Provider | BUSTAMANTE |
| First Name Of The Provider | MARIO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 343 W HOUSTON |
| Street Address 2 Of The Provider | #406 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 78205 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 148 |
| Number Of Services | 5446 |
| Number Of Medicare Beneficiaries | 566 |
| Total Submitted Charge Amount | 755479.97 |
| Total Medicare Allowed Amount | 413294.88 |
| Total Medicare Payment Amount | 310534.3 |
| Total Medicare Standardized Payment Amount | 314655.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1407 |
| Number Of Medicare Beneficiaries With Drug Services | 219 |
| Total Drug Submitted ChargeAmount | 32312 |
| Total Drug Medicare AllowedAmount | 13786.01 |
| Total Drug Medicare PaymentAmount | 10736.73 |
| Total Drug Medicare Standardized Payment Amount | 10736.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 144 |
| Number Of Medical Services | 4039 |
| Number Of Medicare Beneficiaries With Medical Services | 566 |
| Total Medical Submitted Charge Amount | 723167.97 |
| Total Medical Medicare Allowed Amount | 399508.87 |
| Total Medical Medicare Payment Amount | 299797.57 |
| Total Medical Medicare Standardized Payment Amount | 303918.74 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 156 |
| Number Of Beneficiaries Age 65 to 74 | 198 |
| Number Of Beneficiaries Age 75 to 84 | 142 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 367 |
| Number Of Male Beneficiaries | 199 |
| Number Of Non Hispanic White Beneficiaries | 88 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 439 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 248 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 318 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.887 |