| National Provider Identifier [NPI]: | 1053545582 |
| Last Name Of The Provider | FAMY |
| First Name Of The Provider | DANTE |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | APN |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3835 S JONES BLVD STE 104 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891032283 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1265 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 128963.1 |
| Total Medicare Allowed Amount | 29984.16 |
| Total Medicare Payment Amount | 23405.83 |
| Total Medicare Standardized Payment Amount | 26294.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 755 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 14789.1 |
| Total Drug Medicare AllowedAmount | 153.97 |
| Total Drug Medicare PaymentAmount | 118.48 |
| Total Drug Medicare Standardized Payment Amount | 118.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 510 |
| Number Of Medicare Beneficiaries With Medical Services | 151 |
| Total Medical Submitted Charge Amount | 114174 |
| Total Medical Medicare Allowed Amount | 29830.19 |
| Total Medical Medicare Payment Amount | 23287.35 |
| Total Medical Medicare Standardized Payment Amount | 26176.14 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 52 |
| Number Of Non Hispanic White Beneficiaries | 95 |
| Number Of Black or African American Beneficiaries | 33 |
| 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 | 102 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2156 |