| National Provider Identifier [NPI]: | 1386764850 |
| Last Name Of The Provider | CASTELLON |
| First Name Of The Provider | MAURICIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21298 OLEAN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT CHARLOTTE |
| Zip Code Of The Provider | 339526765 |
| 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 | 183 |
| Number Of Services | 11957 |
| Number Of Medicare Beneficiaries | 3831 |
| Total Submitted Charge Amount | 1029974.32 |
| Total Medicare Allowed Amount | 369214.76 |
| Total Medicare Payment Amount | 279279.87 |
| Total Medicare Standardized Payment Amount | 287290.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 6492 |
| Number Of Medicare Beneficiaries With Drug Services | 94 |
| Total Drug Submitted ChargeAmount | 9732 |
| Total Drug Medicare AllowedAmount | 2731.98 |
| Total Drug Medicare PaymentAmount | 2141.75 |
| Total Drug Medicare Standardized Payment Amount | 2141.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 178 |
| Number Of Medical Services | 5465 |
| Number Of Medicare Beneficiaries With Medical Services | 3829 |
| Total Medical Submitted Charge Amount | 1020242.32 |
| Total Medical Medicare Allowed Amount | 366482.78 |
| Total Medical Medicare Payment Amount | 277138.12 |
| Total Medical Medicare Standardized Payment Amount | 285149.13 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 300 |
| Number Of Beneficiaries Age 65 to 74 | 1717 |
| Number Of Beneficiaries Age 75 to 84 | 1327 |
| Number Of Beneficiaries Age Greater 84 | 487 |
| Number Of Female Beneficiaries | 2293 |
| Number Of Male Beneficiaries | 1538 |
| Number Of Non Hispanic White Beneficiaries | 3527 |
| Number Of Black or African American Beneficiaries | 130 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 98 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 61 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 314 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3079 |