| National Provider Identifier [NPI]: | 1104891472 |
| Last Name Of The Provider | BOSS |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 705 DALLAS HWY |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | VILLA RICA |
| Zip Code Of The Provider | 301801247 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 2171 |
| Number Of Medicare Beneficiaries | 452 |
| Total Submitted Charge Amount | 196556 |
| Total Medicare Allowed Amount | 124702.47 |
| Total Medicare Payment Amount | 79241.16 |
| Total Medicare Standardized Payment Amount | 86765.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 414 |
| Number Of Medicare Beneficiaries With Drug Services | 153 |
| Total Drug Submitted ChargeAmount | 9747 |
| Total Drug Medicare AllowedAmount | 2786.22 |
| Total Drug Medicare PaymentAmount | 2370.63 |
| Total Drug Medicare Standardized Payment Amount | 2370.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1757 |
| Number Of Medicare Beneficiaries With Medical Services | 452 |
| Total Medical Submitted Charge Amount | 186809 |
| Total Medical Medicare Allowed Amount | 121916.25 |
| Total Medical Medicare Payment Amount | 76870.53 |
| Total Medical Medicare Standardized Payment Amount | 84394.58 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 215 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 235 |
| Number Of Non Hispanic White Beneficiaries | 389 |
| Number Of Black or African American Beneficiaries | 47 |
| 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 | 376 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0291 |