| National Provider Identifier [NPI]: | 1639152457 |
| Last Name Of The Provider | PASSALACQUA |
| First Name Of The Provider | MATTHEW |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11100 EUCLID AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 44106 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 1210 |
| Number Of Medicare Beneficiaries | 232 |
| Total Submitted Charge Amount | 649407.49 |
| Total Medicare Allowed Amount | 132457.65 |
| Total Medicare Payment Amount | 102559.43 |
| Total Medicare Standardized Payment Amount | 107997.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 490 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 490 |
| Total Drug Medicare AllowedAmount | 116.16 |
| Total Drug Medicare PaymentAmount | 91.08 |
| Total Drug Medicare Standardized Payment Amount | 91.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 109 |
| Number Of Medical Services | 720 |
| Number Of Medicare Beneficiaries With Medical Services | 232 |
| Total Medical Submitted Charge Amount | 648917.49 |
| Total Medical Medicare Allowed Amount | 132341.49 |
| Total Medical Medicare Payment Amount | 102468.35 |
| Total Medical Medicare Standardized Payment Amount | 107906.74 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 104 |
| Number Of Non Hispanic White Beneficiaries | 119 |
| 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 | 151 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 28 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 71 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 4.3327 |