| National Provider Identifier [NPI]: | 1811901390 |
| Last Name Of The Provider | MONTOYA |
| First Name Of The Provider | PAUL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17675 WELCH PLZ |
| Street Address 2 Of The Provider | |
| City Of The Provider | OMAHA |
| Zip Code Of The Provider | 681353551 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 2149 |
| Number Of Medicare Beneficiaries | 439 |
| Total Submitted Charge Amount | 217645.56 |
| Total Medicare Allowed Amount | 110179.84 |
| Total Medicare Payment Amount | 75079.2 |
| Total Medicare Standardized Payment Amount | 81610.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 605 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 13355 |
| Total Drug Medicare AllowedAmount | 7468.24 |
| Total Drug Medicare PaymentAmount | 5889.58 |
| Total Drug Medicare Standardized Payment Amount | 5889.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 82 |
| Number Of Medical Services | 1544 |
| Number Of Medicare Beneficiaries With Medical Services | 437 |
| Total Medical Submitted Charge Amount | 204290.56 |
| Total Medical Medicare Allowed Amount | 102711.6 |
| Total Medical Medicare Payment Amount | 69189.62 |
| Total Medical Medicare Standardized Payment Amount | 75720.82 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 103 |
| Number Of Beneficiaries Age 65 to 74 | 172 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 223 |
| Number Of Male Beneficiaries | 216 |
| Number Of Non Hispanic White Beneficiaries | 416 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0358 |