| National Provider Identifier [NPI]: | 1467890442 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | ALFRED |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4411 MEDICAL DR |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782293822 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 587 |
| Number Of Medicare Beneficiaries | 142 |
| Total Submitted Charge Amount | 41164.24 |
| Total Medicare Allowed Amount | 19770.49 |
| Total Medicare Payment Amount | 14377.57 |
| Total Medicare Standardized Payment Amount | 18499.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 123 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 2525.03 |
| Total Drug Medicare AllowedAmount | 523.06 |
| Total Drug Medicare PaymentAmount | 328.55 |
| Total Drug Medicare Standardized Payment Amount | 328.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 464 |
| Number Of Medicare Beneficiaries With Medical Services | 142 |
| Total Medical Submitted Charge Amount | 38639.21 |
| Total Medical Medicare Allowed Amount | 19247.43 |
| Total Medical Medicare Payment Amount | 14049.02 |
| Total Medical Medicare Standardized Payment Amount | 18171.39 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 64 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 100 |
| Number Of Male Beneficiaries | 42 |
| Number Of Non Hispanic White Beneficiaries | 46 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 80 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0855 |