| National Provider Identifier [NPI]: | 1629237276 |
| Last Name Of The Provider | BELLO |
| First Name Of The Provider | JUSTINE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 154 EXTON SQUARE MALL |
| Street Address 2 Of The Provider | MAIN LINE HEALTH CENTER |
| City Of The Provider | EXTON |
| Zip Code Of The Provider | 193412440 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 251 |
| Number Of Medicare Beneficiaries | 89 |
| Total Submitted Charge Amount | 34690.2 |
| Total Medicare Allowed Amount | 20758.22 |
| Total Medicare Payment Amount | 15330.39 |
| Total Medicare Standardized Payment Amount | 14773.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1962.2 |
| Total Drug Medicare AllowedAmount | 1006.12 |
| Total Drug Medicare PaymentAmount | 985.94 |
| Total Drug Medicare Standardized Payment Amount | 985.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 230 |
| Number Of Medicare Beneficiaries With Medical Services | 89 |
| Total Medical Submitted Charge Amount | 32728 |
| Total Medical Medicare Allowed Amount | 19752.1 |
| Total Medical Medicare Payment Amount | 14344.45 |
| Total Medical Medicare Standardized Payment Amount | 13787.98 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 71 |
| Number Of Male Beneficiaries | 18 |
| 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 | 78 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.882 |