| National Provider Identifier [NPI]: | 1720422991 |
| Last Name Of The Provider | MONTECILLO |
| First Name Of The Provider | THERESA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | APN |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3750 S JONES BLVD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891032208 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1063 |
| Number Of Medicare Beneficiaries | 449 |
| Total Submitted Charge Amount | 319400 |
| Total Medicare Allowed Amount | 141309.67 |
| Total Medicare Payment Amount | 104917.66 |
| Total Medicare Standardized Payment Amount | 121942.46 |
| Drug Suppress Indicator | * |
| Number Of HCPCS Associated With Drug Services | |
| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
| Total Drug Medicare AllowedAmount | |
| Total Drug Medicare PaymentAmount | |
| Total Drug Medicare Standardized Payment Amount | |
| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
| Number Of Medical Services | |
| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
| Total Medical Medicare Payment Amount | |
| Total Medical Medicare Standardized Payment Amount | |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 157 |
| Number Of Beneficiaries Age 65 to 74 | 154 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 48 |
| Number Of Female Beneficiaries | 235 |
| Number Of Male Beneficiaries | 214 |
| Number Of Non Hispanic White Beneficiaries | 181 |
| Number Of Black or African American Beneficiaries | 148 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 172 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 277 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0743 |