| National Provider Identifier [NPI]: | 1215098330 |
| Last Name Of The Provider | RIVERA |
| First Name Of The Provider | ROBERTO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1185 MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILLIMANTIC |
| Zip Code Of The Provider | 062262093 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 276 |
| Number Of Medicare Beneficiaries | 264 |
| Total Submitted Charge Amount | 113895.1 |
| Total Medicare Allowed Amount | 25292.43 |
| Total Medicare Payment Amount | 19563.91 |
| Total Medicare Standardized Payment Amount | 18525.43 |
| 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 | 33 |
| Number Of Medical Services | 276 |
| Number Of Medicare Beneficiaries With Medical Services | 264 |
| Total Medical Submitted Charge Amount | 113895.1 |
| Total Medical Medicare Allowed Amount | 25292.43 |
| Total Medical Medicare Payment Amount | 19563.91 |
| Total Medical Medicare Standardized Payment Amount | 18525.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 115 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 148 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 232 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 188 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1956 |