| National Provider Identifier [NPI]: | 1700027166 |
| Last Name Of The Provider | POWELL |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 BROOKLINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022155400 |
| 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 | 184 |
| Number Of Services | 3736 |
| Number Of Medicare Beneficiaries | 2463 |
| Total Submitted Charge Amount | 496497 |
| Total Medicare Allowed Amount | 160243.81 |
| Total Medicare Payment Amount | 120145.29 |
| Total Medicare Standardized Payment Amount | 119826.48 |
| 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 | 184 |
| Number Of Medical Services | 3736 |
| Number Of Medicare Beneficiaries With Medical Services | 2463 |
| Total Medical Submitted Charge Amount | 496497 |
| Total Medical Medicare Allowed Amount | 160243.81 |
| Total Medical Medicare Payment Amount | 120145.29 |
| Total Medical Medicare Standardized Payment Amount | 119826.48 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 659 |
| Number Of Beneficiaries Age 65 to 74 | 806 |
| Number Of Beneficiaries Age 75 to 84 | 577 |
| Number Of Beneficiaries Age Greater 84 | 421 |
| Number Of Female Beneficiaries | 1454 |
| Number Of Male Beneficiaries | 1009 |
| Number Of Non Hispanic White Beneficiaries | 2078 |
| Number Of Black or African American Beneficiaries | 151 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 146 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1420 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1043 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8381 |