| National Provider Identifier [NPI]: | 1720070220 |
| Last Name Of The Provider | MONTECALVO |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4323 POND APPLE DR S |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341198535 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 122 |
| Number Of Services | 2772 |
| Number Of Medicare Beneficiaries | 2083 |
| Total Submitted Charge Amount | 287301 |
| Total Medicare Allowed Amount | 77738.08 |
| Total Medicare Payment Amount | 60716.73 |
| Total Medicare Standardized Payment Amount | 58694.71 |
| 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 | 122 |
| Number Of Medical Services | 2772 |
| Number Of Medicare Beneficiaries With Medical Services | 2083 |
| Total Medical Submitted Charge Amount | 287301 |
| Total Medical Medicare Allowed Amount | 77738.08 |
| Total Medical Medicare Payment Amount | 60716.73 |
| Total Medical Medicare Standardized Payment Amount | 58694.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 469 |
| Number Of Beneficiaries Age 65 to 74 | 556 |
| Number Of Beneficiaries Age 75 to 84 | 600 |
| Number Of Beneficiaries Age Greater 84 | 458 |
| Number Of Female Beneficiaries | 1222 |
| Number Of Male Beneficiaries | 861 |
| Number Of Non Hispanic White Beneficiaries | 1577 |
| Number Of Black or African American Beneficiaries | 360 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1212 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 871 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 2.5441 |