| National Provider Identifier [NPI]: | 1699717090 |
| Last Name Of The Provider | CHACHO |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 24 HOSPITAL AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANBURY |
| Zip Code Of The Provider | 068106099 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 2458 |
| Number Of Medicare Beneficiaries | 1079 |
| Total Submitted Charge Amount | 538584 |
| Total Medicare Allowed Amount | 100512.83 |
| Total Medicare Payment Amount | 76769.97 |
| Total Medicare Standardized Payment Amount | 56281.92 |
| 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 | 30 |
| Number Of Medical Services | 2458 |
| Number Of Medicare Beneficiaries With Medical Services | 1079 |
| Total Medical Submitted Charge Amount | 538584 |
| Total Medical Medicare Allowed Amount | 100512.83 |
| Total Medical Medicare Payment Amount | 76769.97 |
| Total Medical Medicare Standardized Payment Amount | 56281.92 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 107 |
| Number Of Beneficiaries Age 65 to 74 | 470 |
| Number Of Beneficiaries Age 75 to 84 | 359 |
| Number Of Beneficiaries Age Greater 84 | 143 |
| Number Of Female Beneficiaries | 582 |
| Number Of Male Beneficiaries | 497 |
| Number Of Non Hispanic White Beneficiaries | 977 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 856 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 223 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3916 |