| National Provider Identifier [NPI]: | 1033343991 |
| Last Name Of The Provider | RASTARHUYEVA |
| First Name Of The Provider | IRYNA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 450 BROOKLINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022155418 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 6763 |
| Number Of Medicare Beneficiaries | 482 |
| Total Submitted Charge Amount | 205651 |
| Total Medicare Allowed Amount | 69617.63 |
| Total Medicare Payment Amount | 55520.5 |
| Total Medicare Standardized Payment Amount | 53268.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 6110 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 6110 |
| Total Drug Medicare AllowedAmount | 1440.03 |
| Total Drug Medicare PaymentAmount | 1129.05 |
| Total Drug Medicare Standardized Payment Amount | 1129.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 653 |
| Number Of Medicare Beneficiaries With Medical Services | 482 |
| Total Medical Submitted Charge Amount | 199541 |
| Total Medical Medicare Allowed Amount | 68177.6 |
| Total Medical Medicare Payment Amount | 54391.45 |
| Total Medical Medicare Standardized Payment Amount | 52139.01 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 233 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 289 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 428 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2307 |