| National Provider Identifier [NPI]: | 1700167822 |
| Last Name Of The Provider | GONZALO |
| First Name Of The Provider | TIFFANY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1120 COCOA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HERSHEY |
| Zip Code Of The Provider | 170331712 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 290 |
| Number Of Medicare Beneficiaries | 97 |
| Total Submitted Charge Amount | 21289 |
| Total Medicare Allowed Amount | 11463.5 |
| Total Medicare Payment Amount | 7500.75 |
| Total Medicare Standardized Payment Amount | 9183.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 1358 |
| Total Drug Medicare AllowedAmount | 954.13 |
| Total Drug Medicare PaymentAmount | 930.36 |
| Total Drug Medicare Standardized Payment Amount | 930.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 273 |
| Number Of Medicare Beneficiaries With Medical Services | 97 |
| Total Medical Submitted Charge Amount | 19931 |
| Total Medical Medicare Allowed Amount | 10509.37 |
| Total Medical Medicare Payment Amount | 6570.39 |
| Total Medical Medicare Standardized Payment Amount | 8253.12 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 70 |
| Number Of Male Beneficiaries | 27 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 37 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9947 |