| National Provider Identifier [NPI]: | 1811975600 |
| Last Name Of The Provider | BOLANIS |
| First Name Of The Provider | NANCY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2014 WASHINGTON ST |
| Street Address 2 Of The Provider | NEWTON WELLESLEY RADIOLOGY ASSOCIATES |
| City Of The Provider | NEWTON |
| Zip Code Of The Provider | 02462 |
| 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 | 126 |
| Number Of Services | 4725 |
| Number Of Medicare Beneficiaries | 2955 |
| Total Submitted Charge Amount | 382422 |
| Total Medicare Allowed Amount | 127378.57 |
| Total Medicare Payment Amount | 98453.84 |
| Total Medicare Standardized Payment Amount | 95861.18 |
| 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 | 126 |
| Number Of Medical Services | 4725 |
| Number Of Medicare Beneficiaries With Medical Services | 2955 |
| Total Medical Submitted Charge Amount | 382422 |
| Total Medical Medicare Allowed Amount | 127378.57 |
| Total Medical Medicare Payment Amount | 98453.84 |
| Total Medical Medicare Standardized Payment Amount | 95861.18 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 280 |
| Number Of Beneficiaries Age 65 to 74 | 1103 |
| Number Of Beneficiaries Age 75 to 84 | 874 |
| Number Of Beneficiaries Age Greater 84 | 698 |
| Number Of Female Beneficiaries | 1968 |
| Number Of Male Beneficiaries | 987 |
| Number Of Non Hispanic White Beneficiaries | 2733 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 54 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 71 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2476 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 479 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.3889 |