| National Provider Identifier [NPI]: | 1205830106 |
| Last Name Of The Provider | FUNICELLA |
| First Name Of The Provider | TONI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13740 RESEARCH BLVD |
| Street Address 2 Of The Provider | STE P4 |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787501835 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 5089 |
| Number Of Medicare Beneficiaries | 956 |
| Total Submitted Charge Amount | 440917 |
| Total Medicare Allowed Amount | 205429.61 |
| Total Medicare Payment Amount | 142026.22 |
| Total Medicare Standardized Payment Amount | 145309.49 |
| 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 | 44 |
| Number Of Medical Services | 5089 |
| Number Of Medicare Beneficiaries With Medical Services | 956 |
| Total Medical Submitted Charge Amount | 440917 |
| Total Medical Medicare Allowed Amount | 205429.61 |
| Total Medical Medicare Payment Amount | 142026.22 |
| Total Medical Medicare Standardized Payment Amount | 145309.49 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 410 |
| Number Of Beneficiaries Age 75 to 84 | 390 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 528 |
| Number Of Male Beneficiaries | 428 |
| Number Of Non Hispanic White Beneficiaries | 921 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 9 |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8004 |