| National Provider Identifier [NPI]: | 1639169618 |
| Last Name Of The Provider | ANTONELLI |
| First Name Of The Provider | LISA |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2100 DORCHESTER AVENUE |
| Street Address 2 Of The Provider | SMG - CARNEY HOSPITAL |
| City Of The Provider | DORCHESTER |
| Zip Code Of The Provider | 02124 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 2552 |
| Number Of Medicare Beneficiaries | 1165 |
| Total Submitted Charge Amount | 334974 |
| Total Medicare Allowed Amount | 119604.53 |
| Total Medicare Payment Amount | 91526.4 |
| Total Medicare Standardized Payment Amount | 97555.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 2552 |
| Number Of Medicare Beneficiaries With Medical Services | 1165 |
| Total Medical Submitted Charge Amount | 334974 |
| Total Medical Medicare Allowed Amount | 119604.53 |
| Total Medical Medicare Payment Amount | 91526.4 |
| Total Medical Medicare Standardized Payment Amount | 97555.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 235 |
| Number Of Beneficiaries Age 65 to 74 | 434 |
| Number Of Beneficiaries Age 75 to 84 | 342 |
| Number Of Beneficiaries Age Greater 84 | 154 |
| Number Of Female Beneficiaries | 588 |
| Number Of Male Beneficiaries | 577 |
| Number Of Non Hispanic White Beneficiaries | 1025 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 65 |
| Number Of American Indian Alaska Native Beneficiaries | 33 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 822 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 343 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6225 |