| National Provider Identifier [NPI]: | 1093848921 |
| Last Name Of The Provider | COLOMB-LIPPA |
| First Name Of The Provider | DAWN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | PHYSICIAN ASSISTANT |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 CHASE PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | WATERBURY |
| Zip Code Of The Provider | 067083346 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 20 |
| Number Of Services | 396 |
| Number Of Medicare Beneficiaries | 66 |
| Total Submitted Charge Amount | 114461.93 |
| Total Medicare Allowed Amount | 36181.53 |
| Total Medicare Payment Amount | 27802.31 |
| Total Medicare Standardized Payment Amount | 28305.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 152 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 59681.75 |
| Total Drug Medicare AllowedAmount | 22044.89 |
| Total Drug Medicare PaymentAmount | 17139.06 |
| Total Drug Medicare Standardized Payment Amount | 17139.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 244 |
| Number Of Medicare Beneficiaries With Medical Services | 66 |
| Total Medical Submitted Charge Amount | 54780.18 |
| Total Medical Medicare Allowed Amount | 14136.64 |
| Total Medical Medicare Payment Amount | 10663.25 |
| Total Medical Medicare Standardized Payment Amount | 11166.17 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 25 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 50 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 54 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0584 |