| National Provider Identifier [NPI]: | 1699743708 |
| Last Name Of The Provider | PAULOS |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 164 SUMMIT AVE |
| Street Address 2 Of The Provider | FAIN BLDING |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029062853 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 388 |
| Number Of Medicare Beneficiaries | 119 |
| Total Submitted Charge Amount | 69292.02 |
| Total Medicare Allowed Amount | 32046.67 |
| Total Medicare Payment Amount | 22906.96 |
| Total Medicare Standardized Payment Amount | 22293.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 2282.28 |
| Total Drug Medicare AllowedAmount | 181.05 |
| Total Drug Medicare PaymentAmount | 120.8 |
| Total Drug Medicare Standardized Payment Amount | 120.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 11 |
| Number Of Medical Services | 346 |
| Number Of Medicare Beneficiaries With Medical Services | 119 |
| Total Medical Submitted Charge Amount | 67009.74 |
| Total Medical Medicare Allowed Amount | 31865.62 |
| Total Medical Medicare Payment Amount | 22786.16 |
| Total Medical Medicare Standardized Payment Amount | 22172.86 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 12 |
| Number Of Beneficiaries Age Greater 84 | 0 |
| Number Of Female Beneficiaries | 0 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | 84 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 77 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 52 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1605 |