| National Provider Identifier [NPI]: | 1679650709 |
| Last Name Of The Provider | ORTEGON |
| First Name Of The Provider | ANTHONY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 314 W 16TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 81003 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 26196 |
| Number Of Medicare Beneficiaries | 1020 |
| Total Submitted Charge Amount | 1165946.34 |
| Total Medicare Allowed Amount | 1041512.36 |
| Total Medicare Payment Amount | 774709.55 |
| Total Medicare Standardized Payment Amount | 742638.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 9695 |
| Number Of Medicare Beneficiaries With Drug Services | 439 |
| Total Drug Submitted ChargeAmount | 12976.99 |
| Total Drug Medicare AllowedAmount | 8319.39 |
| Total Drug Medicare PaymentAmount | 7111.05 |
| Total Drug Medicare Standardized Payment Amount | 7111.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 16501 |
| Number Of Medicare Beneficiaries With Medical Services | 1020 |
| Total Medical Submitted Charge Amount | 1152969.35 |
| Total Medical Medicare Allowed Amount | 1033192.97 |
| Total Medical Medicare Payment Amount | 767598.5 |
| Total Medical Medicare Standardized Payment Amount | 735527.84 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 425 |
| Number Of Beneficiaries Age 65 to 74 | 286 |
| Number Of Beneficiaries Age 75 to 84 | 191 |
| Number Of Beneficiaries Age Greater 84 | 118 |
| Number Of Female Beneficiaries | 555 |
| Number Of Male Beneficiaries | 465 |
| Number Of Non Hispanic White Beneficiaries | 532 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 455 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 430 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 590 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 40 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6347 |