| National Provider Identifier [NPI]: | 1003881350 |
| Last Name Of The Provider | STAMBO |
| First Name Of The Provider | GLENN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4516 N ARMENIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336032732 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 304 |
| Number Of Services | 10850 |
| Number Of Medicare Beneficiaries | 3024 |
| Total Submitted Charge Amount | 1080737.36 |
| Total Medicare Allowed Amount | 257398.47 |
| Total Medicare Payment Amount | 196856.53 |
| Total Medicare Standardized Payment Amount | 195944.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6015 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 17506.4 |
| Total Drug Medicare AllowedAmount | 1374.51 |
| Total Drug Medicare PaymentAmount | 1067.33 |
| Total Drug Medicare Standardized Payment Amount | 1067.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 301 |
| Number Of Medical Services | 4835 |
| Number Of Medicare Beneficiaries With Medical Services | 3024 |
| Total Medical Submitted Charge Amount | 1063230.96 |
| Total Medical Medicare Allowed Amount | 256023.96 |
| Total Medical Medicare Payment Amount | 195789.2 |
| Total Medical Medicare Standardized Payment Amount | 194877.36 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 475 |
| Number Of Beneficiaries Age 65 to 74 | 955 |
| Number Of Beneficiaries Age 75 to 84 | 927 |
| Number Of Beneficiaries Age Greater 84 | 667 |
| Number Of Female Beneficiaries | 1796 |
| Number Of Male Beneficiaries | 1228 |
| Number Of Non Hispanic White Beneficiaries | 1943 |
| Number Of Black or African American Beneficiaries | 366 |
| Number Of AsianPacific Islander Beneficiaries | 36 |
| Number Of Hispanic Beneficiaries | 652 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1952 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1072 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.1032 |