| National Provider Identifier [NPI]: | 1528012655 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9240 BONITA BEACH RD |
| Street Address 2 Of The Provider | SUITE 1106 |
| City Of The Provider | BONITA SPRINGS |
| Zip Code Of The Provider | 341354249 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Otolaryngology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 12249 |
| Number Of Medicare Beneficiaries | 2084 |
| Total Submitted Charge Amount | 1489568 |
| Total Medicare Allowed Amount | 739088.86 |
| Total Medicare Payment Amount | 538548.99 |
| Total Medicare Standardized Payment Amount | 513854.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 12249 |
| Number Of Medicare Beneficiaries With Medical Services | 2084 |
| Total Medical Submitted Charge Amount | 1489568 |
| Total Medical Medicare Allowed Amount | 739088.86 |
| Total Medical Medicare Payment Amount | 538548.99 |
| Total Medical Medicare Standardized Payment Amount | 513854.7 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 973 |
| Number Of Beneficiaries Age 75 to 84 | 803 |
| Number Of Beneficiaries Age Greater 84 | 261 |
| Number Of Female Beneficiaries | 1131 |
| Number Of Male Beneficiaries | 953 |
| Number Of Non Hispanic White Beneficiaries | 2017 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2062 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9555 |