| National Provider Identifier [NPI]: | 1003880154 |
| Last Name Of The Provider | BOMBERO |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 730 GOODLETTE RD N |
| Street Address 2 Of The Provider | STE 205 |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341025618 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 775 |
| Number Of Medicare Beneficiaries | 308 |
| Total Submitted Charge Amount | 88013.25 |
| Total Medicare Allowed Amount | 39486.43 |
| Total Medicare Payment Amount | 30357.25 |
| Total Medicare Standardized Payment Amount | 33894.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 307 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 13259.25 |
| Total Drug Medicare AllowedAmount | 5268.15 |
| Total Drug Medicare PaymentAmount | 4129.02 |
| Total Drug Medicare Standardized Payment Amount | 4129.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 468 |
| Number Of Medicare Beneficiaries With Medical Services | 308 |
| Total Medical Submitted Charge Amount | 74754 |
| Total Medical Medicare Allowed Amount | 34218.28 |
| Total Medical Medicare Payment Amount | 26228.23 |
| Total Medical Medicare Standardized Payment Amount | 29765.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 147 |
| Number Of Beneficiaries Age 75 to 84 | 117 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 216 |
| Number Of Male Beneficiaries | 92 |
| Number Of Non Hispanic White Beneficiaries | 294 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 26 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2358 |