| National Provider Identifier [NPI]: | 1285612036 |
| Last Name Of The Provider | CUSUMANO |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 178 E DAVIS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336063514 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 1710 |
| Number Of Medicare Beneficiaries | 1009 |
| Total Submitted Charge Amount | 158638.66 |
| Total Medicare Allowed Amount | 148231.46 |
| Total Medicare Payment Amount | 99527.37 |
| Total Medicare Standardized Payment Amount | 100503.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 1710 |
| Number Of Medicare Beneficiaries With Medical Services | 1009 |
| Total Medical Submitted Charge Amount | 158638.66 |
| Total Medical Medicare Allowed Amount | 148231.46 |
| Total Medical Medicare Payment Amount | 99527.37 |
| Total Medical Medicare Standardized Payment Amount | 100503.02 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | 124 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 248 |
| Number Of Beneficiaries Age Greater 84 | 468 |
| Number Of Female Beneficiaries | 677 |
| Number Of Male Beneficiaries | 332 |
| Number Of Non Hispanic White Beneficiaries | 790 |
| Number Of Black or African American Beneficiaries | 149 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 108 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 901 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 67 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.6458 |