| National Provider Identifier [NPI]: | 1730132135 |
| Last Name Of The Provider | BEVILACQUA |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 680 CENTRE ST |
| Street Address 2 Of The Provider | RADIOLOGY DEPARTMENT |
| City Of The Provider | BROCKTON |
| Zip Code Of The Provider | 023023308 |
| 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 | 89 |
| Number Of Services | 1269 |
| Number Of Medicare Beneficiaries | 729 |
| Total Submitted Charge Amount | 96923 |
| Total Medicare Allowed Amount | 34326.33 |
| Total Medicare Payment Amount | 26192.62 |
| Total Medicare Standardized Payment Amount | 25610.61 |
| 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 | 89 |
| Number Of Medical Services | 1269 |
| Number Of Medicare Beneficiaries With Medical Services | 729 |
| Total Medical Submitted Charge Amount | 96923 |
| Total Medical Medicare Allowed Amount | 34326.33 |
| Total Medical Medicare Payment Amount | 26192.62 |
| Total Medical Medicare Standardized Payment Amount | 25610.61 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 249 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 156 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 470 |
| Number Of Male Beneficiaries | 259 |
| Number Of Non Hispanic White Beneficiaries | 606 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 395 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 334 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7264 |