| National Provider Identifier [NPI]: | 1780619932 |
| Last Name Of The Provider | KAILATH |
| First Name Of The Provider | ANN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1832 CENTRE STREET |
| Street Address 2 Of The Provider | WEST ROXBURY MEDICAL GROUP FAULKNER HOSPITAL |
| City Of The Provider | WEST ROXBURY |
| Zip Code Of The Provider | 02130 |
| 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 | 29 |
| Number Of Services | 946 |
| Number Of Medicare Beneficiaries | 169 |
| Total Submitted Charge Amount | 172361 |
| Total Medicare Allowed Amount | 52468.23 |
| Total Medicare Payment Amount | 38590.23 |
| Total Medicare Standardized Payment Amount | 35995.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 4377 |
| Total Drug Medicare AllowedAmount | 2531.12 |
| Total Drug Medicare PaymentAmount | 2452.88 |
| Total Drug Medicare Standardized Payment Amount | 2452.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 831 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 167984 |
| Total Medical Medicare Allowed Amount | 49937.11 |
| Total Medical Medicare Payment Amount | 36137.35 |
| Total Medical Medicare Standardized Payment Amount | 33543.11 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 13 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 53 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 150 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | 148 |
| 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 | 139 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 30 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 33 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0427 |