| National Provider Identifier [NPI]: | 1285692897 |
| Last Name Of The Provider | ACKMAN |
| First Name Of The Provider | JEANNE |
| Middle Initial Of The Provider | B |
| 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 | MGH DEPARTMENT OF RADIOLOGY, FOUNDERS HOUSE 2 |
| 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 | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 19556 |
| Number Of Medicare Beneficiaries | 2376 |
| Total Submitted Charge Amount | 720332 |
| Total Medicare Allowed Amount | 155512.8 |
| Total Medicare Payment Amount | 115934.58 |
| Total Medicare Standardized Payment Amount | 111894.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 16405 |
| Number Of Medicare Beneficiaries With Drug Services | 195 |
| Total Drug Submitted ChargeAmount | 17045 |
| Total Drug Medicare AllowedAmount | 3219.12 |
| Total Drug Medicare PaymentAmount | 2523.68 |
| Total Drug Medicare Standardized Payment Amount | 2523.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 3151 |
| Number Of Medicare Beneficiaries With Medical Services | 2375 |
| Total Medical Submitted Charge Amount | 703287 |
| Total Medical Medicare Allowed Amount | 152293.68 |
| Total Medical Medicare Payment Amount | 113410.9 |
| Total Medical Medicare Standardized Payment Amount | 109370.94 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 356 |
| Number Of Beneficiaries Age 65 to 74 | 973 |
| Number Of Beneficiaries Age 75 to 84 | 759 |
| Number Of Beneficiaries Age Greater 84 | 288 |
| Number Of Female Beneficiaries | 1141 |
| Number Of Male Beneficiaries | 1235 |
| Number Of Non Hispanic White Beneficiaries | 2118 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | 45 |
| Number Of Hispanic Beneficiaries | 75 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 57 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1834 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 542 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 33 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.2529 |