| National Provider Identifier [NPI]: | 1609803410 |
| Last Name Of The Provider | ROTH |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 FRUIT ST |
| Street Address 2 Of The Provider | WHA, YAWKEY 4B |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021142621 |
| 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 | 35 |
| Number Of Services | 469 |
| Number Of Medicare Beneficiaries | 211 |
| Total Submitted Charge Amount | 154424 |
| Total Medicare Allowed Amount | 47160.69 |
| Total Medicare Payment Amount | 33847.35 |
| Total Medicare Standardized Payment Amount | 31903.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 754 |
| Total Drug Medicare AllowedAmount | 536.5 |
| Total Drug Medicare PaymentAmount | 512.27 |
| Total Drug Medicare Standardized Payment Amount | 512.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 457 |
| Number Of Medicare Beneficiaries With Medical Services | 211 |
| Total Medical Submitted Charge Amount | 153670 |
| Total Medical Medicare Allowed Amount | 46624.19 |
| Total Medical Medicare Payment Amount | 33335.08 |
| Total Medical Medicare Standardized Payment Amount | 31390.84 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 106 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 162 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 165 |
| Number Of Black or African American Beneficiaries | 20 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 151 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2795 |