| National Provider Identifier [NPI]: | 1508857780 |
| Last Name Of The Provider | FOSBURGH |
| First Name Of The Provider | BLAIR |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15 PARKMAN ST |
| Street Address 2 Of The Provider | INTERNAL MEDICINE ASSOCIATES TEAM 3 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021143117 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 397 |
| Number Of Medicare Beneficiaries | 214 |
| Total Submitted Charge Amount | 88559 |
| Total Medicare Allowed Amount | 26719.87 |
| Total Medicare Payment Amount | 19992.55 |
| Total Medicare Standardized Payment Amount | 19208.56 |
| 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 | 22 |
| Number Of Medical Services | 397 |
| Number Of Medicare Beneficiaries With Medical Services | 214 |
| Total Medical Submitted Charge Amount | 88559 |
| Total Medical Medicare Allowed Amount | 26719.87 |
| Total Medical Medicare Payment Amount | 19992.55 |
| Total Medical Medicare Standardized Payment Amount | 19208.56 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 83 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 114 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 100 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3253 |