| National Provider Identifier [NPI]: | 1043367097 |
| Last Name Of The Provider | LIBERTINO |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| 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 | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 469 |
| Number Of Medicare Beneficiaries | 231 |
| Total Submitted Charge Amount | 537981.75 |
| Total Medicare Allowed Amount | 129432.94 |
| Total Medicare Payment Amount | 100585.14 |
| Total Medicare Standardized Payment Amount | 97651.62 |
| 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 | 60 |
| Number Of Medical Services | 469 |
| Number Of Medicare Beneficiaries With Medical Services | 231 |
| Total Medical Submitted Charge Amount | 537981.75 |
| Total Medical Medicare Allowed Amount | 129432.94 |
| Total Medical Medicare Payment Amount | 100585.14 |
| Total Medical Medicare Standardized Payment Amount | 97651.62 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 107 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 60 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 219 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 39 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3923 |