| National Provider Identifier [NPI]: | 1124012596 |
| Last Name Of The Provider | BONOMO |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 525 N DACIE PT |
| Street Address 2 Of The Provider | |
| City Of The Provider | LECANTO |
| Zip Code Of The Provider | 344618399 |
| 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 | 75 |
| Number Of Services | 18305 |
| Number Of Medicare Beneficiaries | 4044 |
| Total Submitted Charge Amount | 1560368 |
| Total Medicare Allowed Amount | 839652.95 |
| Total Medicare Payment Amount | 592402.13 |
| Total Medicare Standardized Payment Amount | 699393.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 129 |
| Number Of Medicare Beneficiaries With Drug Services | 107 |
| Total Drug Submitted ChargeAmount | 993 |
| Total Drug Medicare AllowedAmount | 346.28 |
| Total Drug Medicare PaymentAmount | 240.63 |
| Total Drug Medicare Standardized Payment Amount | 240.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 72 |
| Number Of Medical Services | 18176 |
| Number Of Medicare Beneficiaries With Medical Services | 4044 |
| Total Medical Submitted Charge Amount | 1559375 |
| Total Medical Medicare Allowed Amount | 839306.67 |
| Total Medical Medicare Payment Amount | 592161.5 |
| Total Medical Medicare Standardized Payment Amount | 699152.63 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 189 |
| Number Of Beneficiaries Age 65 to 74 | 1673 |
| Number Of Beneficiaries Age 75 to 84 | 1525 |
| Number Of Beneficiaries Age Greater 84 | 657 |
| Number Of Female Beneficiaries | 1827 |
| Number Of Male Beneficiaries | 2217 |
| Number Of Non Hispanic White Beneficiaries | 3903 |
| Number Of Black or African American Beneficiaries | 25 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3807 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 237 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0836 |