| National Provider Identifier [NPI]: | 1750557765 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | JANA |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD SCM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 41 MALL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BURLINGTON |
| Zip Code Of The Provider | 018050001 |
| 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 | 42 |
| Number Of Services | 2866 |
| Number Of Medicare Beneficiaries | 1970 |
| Total Submitted Charge Amount | 263475 |
| Total Medicare Allowed Amount | 78797.87 |
| Total Medicare Payment Amount | 61043.14 |
| Total Medicare Standardized Payment Amount | 58948.21 |
| 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 | 42 |
| Number Of Medical Services | 2866 |
| Number Of Medicare Beneficiaries With Medical Services | 1970 |
| Total Medical Submitted Charge Amount | 263475 |
| Total Medical Medicare Allowed Amount | 78797.87 |
| Total Medical Medicare Payment Amount | 61043.14 |
| Total Medical Medicare Standardized Payment Amount | 58948.21 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 250 |
| Number Of Beneficiaries Age 65 to 74 | 683 |
| Number Of Beneficiaries Age 75 to 84 | 623 |
| Number Of Beneficiaries Age Greater 84 | 414 |
| Number Of Female Beneficiaries | 975 |
| Number Of Male Beneficiaries | 995 |
| Number Of Non Hispanic White Beneficiaries | 1830 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1611 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 359 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7345 |