| National Provider Identifier [NPI]: | 1306857537 |
| Last Name Of The Provider | FONTANA |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PA C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2725 SOUTH 144TH STREET |
| Street Address 2 Of The Provider | SUITE 212 |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 68144 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 802 |
| Number Of Medicare Beneficiaries | 230 |
| Total Submitted Charge Amount | 212129.25 |
| Total Medicare Allowed Amount | 49832.3 |
| Total Medicare Payment Amount | 38337.76 |
| Total Medicare Standardized Payment Amount | 42881.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 430 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 20760 |
| Total Drug Medicare AllowedAmount | 11888.6 |
| Total Drug Medicare PaymentAmount | 9047.36 |
| Total Drug Medicare Standardized Payment Amount | 9047.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 372 |
| Number Of Medicare Beneficiaries With Medical Services | 230 |
| Total Medical Submitted Charge Amount | 191369.25 |
| Total Medical Medicare Allowed Amount | 37943.7 |
| Total Medical Medicare Payment Amount | 29290.4 |
| Total Medical Medicare Standardized Payment Amount | 33834.21 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| 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 | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7629 |