| National Provider Identifier [NPI]: | 1366414385 |
| Last Name Of The Provider | MONTELLESE |
| First Name Of The Provider | PHYLLIS |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 29 JEFFERSON CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | ZION CROSSROADS |
| Zip Code Of The Provider | 229429602 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 2352 |
| Number Of Medicare Beneficiaries | 326 |
| Total Submitted Charge Amount | 177951 |
| Total Medicare Allowed Amount | 121449.2 |
| Total Medicare Payment Amount | 90410.86 |
| Total Medicare Standardized Payment Amount | 92868.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 315 |
| Number Of Medicare Beneficiaries With Drug Services | 133 |
| Total Drug Submitted ChargeAmount | 6679 |
| Total Drug Medicare AllowedAmount | 4084.51 |
| Total Drug Medicare PaymentAmount | 3923.27 |
| Total Drug Medicare Standardized Payment Amount | 3923.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 2037 |
| Number Of Medicare Beneficiaries With Medical Services | 326 |
| Total Medical Submitted Charge Amount | 171272 |
| Total Medical Medicare Allowed Amount | 117364.69 |
| Total Medical Medicare Payment Amount | 86487.59 |
| Total Medical Medicare Standardized Payment Amount | 88945.08 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 156 |
| Number Of Beneficiaries Age 75 to 84 | 92 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 100 |
| Number Of Non Hispanic White Beneficiaries | 290 |
| 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 | 292 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8994 |