| National Provider Identifier [NPI]: | 1124107123 |
| Last Name Of The Provider | MARTIN |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 123 SUMMER STREET |
| Street Address 2 Of The Provider | SUITE 390 |
| City Of The Provider | WORCESTER |
| Zip Code Of The Provider | 01608 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 1332 |
| Number Of Medicare Beneficiaries | 459 |
| Total Submitted Charge Amount | 339997.56 |
| Total Medicare Allowed Amount | 115115.06 |
| Total Medicare Payment Amount | 86248.34 |
| Total Medicare Standardized Payment Amount | 84648.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 658.56 |
| Total Drug Medicare AllowedAmount | 369.68 |
| Total Drug Medicare PaymentAmount | 360.88 |
| Total Drug Medicare Standardized Payment Amount | 360.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1304 |
| Number Of Medicare Beneficiaries With Medical Services | 459 |
| Total Medical Submitted Charge Amount | 339339 |
| Total Medical Medicare Allowed Amount | 114745.38 |
| Total Medical Medicare Payment Amount | 85887.46 |
| Total Medical Medicare Standardized Payment Amount | 84287.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 165 |
| Number Of Beneficiaries Age 75 to 84 | 130 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 216 |
| Number Of Male Beneficiaries | 243 |
| Number Of Non Hispanic White Beneficiaries | 413 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 300 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 159 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 56 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.2271 |