| National Provider Identifier [NPI]: | 1902957020 |
| Last Name Of The Provider | D'AMATO |
| First Name Of The Provider | TINA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 905 ROOSEVELT HWY |
| Street Address 2 Of The Provider | #210 |
| City Of The Provider | COLCHESTER |
| Zip Code Of The Provider | 054464475 |
| State Code Of The Provider | VT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 762 |
| Number Of Medicare Beneficiaries | 87 |
| Total Submitted Charge Amount | 96146.85 |
| Total Medicare Allowed Amount | 58233.64 |
| Total Medicare Payment Amount | 45327.07 |
| Total Medicare Standardized Payment Amount | 45708.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 46 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 928.82 |
| Total Drug Medicare AllowedAmount | 426.67 |
| Total Drug Medicare PaymentAmount | 407.83 |
| Total Drug Medicare Standardized Payment Amount | 407.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 716 |
| Number Of Medicare Beneficiaries With Medical Services | 87 |
| Total Medical Submitted Charge Amount | 95218.03 |
| Total Medical Medicare Allowed Amount | 57806.97 |
| Total Medical Medicare Payment Amount | 44919.24 |
| Total Medical Medicare Standardized Payment Amount | 45300.48 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 23 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 75 |
| Number Of Male Beneficiaries | 12 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 41 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 46 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 17 |
| Percent Of With Hypertension | 30 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 0.902 |