| National Provider Identifier [NPI]: | 1679660021 |
| Last Name Of The Provider | IMEVBORE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 46 PRINCE ST |
| Street Address 2 Of The Provider | SUITE 306 |
| City Of The Provider | NEW HAVEN |
| Zip Code Of The Provider | 065191600 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 6654 |
| Number Of Medicare Beneficiaries | 997 |
| Total Submitted Charge Amount | 2092476.57 |
| Total Medicare Allowed Amount | 799241.7 |
| Total Medicare Payment Amount | 618221.12 |
| Total Medicare Standardized Payment Amount | 582600.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 6296 |
| Total Drug Medicare AllowedAmount | 4720 |
| Total Drug Medicare PaymentAmount | 4474.7 |
| Total Drug Medicare Standardized Payment Amount | 4474.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 6581 |
| Number Of Medicare Beneficiaries With Medical Services | 997 |
| Total Medical Submitted Charge Amount | 2086180.57 |
| Total Medical Medicare Allowed Amount | 794521.7 |
| Total Medical Medicare Payment Amount | 613746.42 |
| Total Medical Medicare Standardized Payment Amount | 578125.36 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 174 |
| Number Of Beneficiaries Age 65 to 74 | 315 |
| Number Of Beneficiaries Age 75 to 84 | 301 |
| Number Of Beneficiaries Age Greater 84 | 207 |
| Number Of Female Beneficiaries | 577 |
| Number Of Male Beneficiaries | 420 |
| Number Of Non Hispanic White Beneficiaries | 766 |
| Number Of Black or African American Beneficiaries | 151 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 599 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 398 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 27 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 62 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.1829 |