| National Provider Identifier [NPI]: | 1063478766 |
| Last Name Of The Provider | FONSECA |
| First Name Of The Provider | GUSTAVO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 521 N LECANTO HWY |
| Street Address 2 Of The Provider | FLORIDA CANCER SPECIALISTS P L |
| City Of The Provider | LECANTO |
| Zip Code Of The Provider | 344619187 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 191 |
| Number Of Services | 373453 |
| Number Of Medicare Beneficiaries | 938 |
| Total Submitted Charge Amount | 11831398 |
| Total Medicare Allowed Amount | 4441939.33 |
| Total Medicare Payment Amount | 3491377.98 |
| Total Medicare Standardized Payment Amount | 3488380.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 76 |
| Number Of Drug Services | 353003 |
| Number Of Medicare Beneficiaries With Drug Services | 438 |
| Total Drug Submitted ChargeAmount | 8640965 |
| Total Drug Medicare AllowedAmount | 3273102.9 |
| Total Drug Medicare PaymentAmount | 2564106.45 |
| Total Drug Medicare Standardized Payment Amount | 2564106.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 20450 |
| Number Of Medicare Beneficiaries With Medical Services | 938 |
| Total Medical Submitted Charge Amount | 3190433 |
| Total Medical Medicare Allowed Amount | 1168836.43 |
| Total Medical Medicare Payment Amount | 927271.53 |
| Total Medical Medicare Standardized Payment Amount | 924273.79 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 363 |
| Number Of Beneficiaries Age 75 to 84 | 355 |
| Number Of Beneficiaries Age Greater 84 | 145 |
| Number Of Female Beneficiaries | 496 |
| Number Of Male Beneficiaries | 442 |
| Number Of Non Hispanic White Beneficiaries | 856 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 825 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 113 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 41 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.0118 |