| National Provider Identifier [NPI]: | 1134174998 |
| Last Name Of The Provider | TELLO |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2923 GINNALA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOVELAND |
| Zip Code Of The Provider | 805382702 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 1847 |
| Number Of Medicare Beneficiaries | 575 |
| Total Submitted Charge Amount | 200734 |
| Total Medicare Allowed Amount | 132986.67 |
| Total Medicare Payment Amount | 93838.9 |
| Total Medicare Standardized Payment Amount | 93546.24 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 272 |
| Number Of Medicare Beneficiaries With Drug Services | 136 |
| Total Drug Submitted ChargeAmount | 8583 |
| Total Drug Medicare AllowedAmount | 5487.02 |
| Total Drug Medicare PaymentAmount | 5218.15 |
| Total Drug Medicare Standardized Payment Amount | 5218.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1575 |
| Number Of Medicare Beneficiaries With Medical Services | 575 |
| Total Medical Submitted Charge Amount | 192151 |
| Total Medical Medicare Allowed Amount | 127499.65 |
| Total Medical Medicare Payment Amount | 88620.75 |
| Total Medical Medicare Standardized Payment Amount | 88328.09 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 211 |
| Number Of Female Beneficiaries | 308 |
| Number Of Male Beneficiaries | 267 |
| Number Of Non Hispanic White Beneficiaries | 552 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 485 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 90 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2506 |