| National Provider Identifier [NPI]: | 1093717167 |
| Last Name Of The Provider | MESA |
| First Name Of The Provider | ANTONIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9090 SW 87TH CT |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331762315 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 1130 |
| Number Of Medicare Beneficiaries | 257 |
| Total Submitted Charge Amount | 634441.58 |
| Total Medicare Allowed Amount | 110689.45 |
| Total Medicare Payment Amount | 85885.19 |
| Total Medicare Standardized Payment Amount | 74111.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 179 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 15031.58 |
| Total Drug Medicare AllowedAmount | 4262.41 |
| Total Drug Medicare PaymentAmount | 3226.57 |
| Total Drug Medicare Standardized Payment Amount | 3226.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 951 |
| Number Of Medicare Beneficiaries With Medical Services | 257 |
| Total Medical Submitted Charge Amount | 619410 |
| Total Medical Medicare Allowed Amount | 106427.04 |
| Total Medical Medicare Payment Amount | 82658.62 |
| Total Medical Medicare Standardized Payment Amount | 70884.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | 26 |
| Number Of Female Beneficiaries | 156 |
| Number Of Male Beneficiaries | 101 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 133 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 153 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 104 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5537 |