| National Provider Identifier [NPI]: | 1851403190 |
| Last Name Of The Provider | TERRITO |
| First Name Of The Provider | CARLA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1224 GRAHAM RD |
| Street Address 2 Of The Provider | SUITE 3011 |
| City Of The Provider | FLORISSANT |
| Zip Code Of The Provider | 630318028 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 11657 |
| Number Of Medicare Beneficiaries | 836 |
| Total Submitted Charge Amount | 2971597.55 |
| Total Medicare Allowed Amount | 2073959.95 |
| Total Medicare Payment Amount | 1601540.29 |
| Total Medicare Standardized Payment Amount | 1614818.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2186 |
| Number Of Medicare Beneficiaries With Drug Services | 176 |
| Total Drug Submitted ChargeAmount | 1416028.17 |
| Total Drug Medicare AllowedAmount | 1383673.07 |
| Total Drug Medicare PaymentAmount | 1084732.83 |
| Total Drug Medicare Standardized Payment Amount | 1084732.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 37 |
| Number Of Medical Services | 9471 |
| Number Of Medicare Beneficiaries With Medical Services | 836 |
| Total Medical Submitted Charge Amount | 1555569.38 |
| Total Medical Medicare Allowed Amount | 690286.88 |
| Total Medical Medicare Payment Amount | 516807.46 |
| Total Medical Medicare Standardized Payment Amount | 530085.22 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 279 |
| Number Of Beneficiaries Age 75 to 84 | 289 |
| Number Of Beneficiaries Age Greater 84 | 228 |
| Number Of Female Beneficiaries | 514 |
| Number Of Male Beneficiaries | 322 |
| Number Of Non Hispanic White Beneficiaries | 760 |
| Number Of Black or African American Beneficiaries | 52 |
| 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 | 798 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 38 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4833 |