| National Provider Identifier [NPI]: | 1699977694 |
| Last Name Of The Provider | MUSTO |
| First Name Of The Provider | MICHELE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6209 BROOKS BARTRAM DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322585601 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 109 |
| Number Of Services | 5217 |
| Number Of Medicare Beneficiaries | 593 |
| Total Submitted Charge Amount | 821395 |
| Total Medicare Allowed Amount | 292140.95 |
| Total Medicare Payment Amount | 229109.31 |
| Total Medicare Standardized Payment Amount | 237548.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 355 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 21761 |
| Total Drug Medicare AllowedAmount | 9990.38 |
| Total Drug Medicare PaymentAmount | 9392.67 |
| Total Drug Medicare Standardized Payment Amount | 9392.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 4862 |
| Number Of Medicare Beneficiaries With Medical Services | 593 |
| Total Medical Submitted Charge Amount | 799634 |
| Total Medical Medicare Allowed Amount | 282150.57 |
| Total Medical Medicare Payment Amount | 219716.64 |
| Total Medical Medicare Standardized Payment Amount | 228155.78 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 197 |
| Number Of Beneficiaries Age 75 to 84 | 171 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 343 |
| Number Of Male Beneficiaries | 250 |
| Number Of Non Hispanic White Beneficiaries | 416 |
| Number Of Black or African American Beneficiaries | 162 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 430 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 163 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.1329 |