| National Provider Identifier [NPI]: | 1538162185 |
| Last Name Of The Provider | PONTELLO |
| First Name Of The Provider | RUBY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | ARNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3426 N ROOSEVELT BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | KEY WEST |
| Zip Code Of The Provider | 330404224 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 21870 |
| Number Of Medicare Beneficiaries | 105 |
| Total Submitted Charge Amount | 1015568.84 |
| Total Medicare Allowed Amount | 342888.77 |
| Total Medicare Payment Amount | 264401.65 |
| Total Medicare Standardized Payment Amount | 264942.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 48 |
| Number Of Drug Services | 20868 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 828481.79 |
| Total Drug Medicare AllowedAmount | 296109.32 |
| Total Drug Medicare PaymentAmount | 231794.08 |
| Total Drug Medicare Standardized Payment Amount | 231794.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 1002 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 187087.05 |
| Total Medical Medicare Allowed Amount | 46779.45 |
| Total Medical Medicare Payment Amount | 32607.57 |
| Total Medical Medicare Standardized Payment Amount | 33148.42 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 55 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 51 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 84 |
| 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 | 90 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 53 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1357 |