| National Provider Identifier [NPI]: | 1568414977 |
| Last Name Of The Provider | GROSSMAN |
| First Name Of The Provider | NEIL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 366 WASHINGTON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WELLESLEY |
| Zip Code Of The Provider | 024816206 |
| 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 | 170 |
| Number Of Services | 3601 |
| Number Of Medicare Beneficiaries | 2228 |
| Total Submitted Charge Amount | 474442 |
| Total Medicare Allowed Amount | 104792.92 |
| Total Medicare Payment Amount | 83468.48 |
| Total Medicare Standardized Payment Amount | 81517.11 |
| 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 | 170 |
| Number Of Medical Services | 3601 |
| Number Of Medicare Beneficiaries With Medical Services | 2228 |
| Total Medical Submitted Charge Amount | 474442 |
| Total Medical Medicare Allowed Amount | 104792.92 |
| Total Medical Medicare Payment Amount | 83468.48 |
| Total Medical Medicare Standardized Payment Amount | 81517.11 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 337 |
| Number Of Beneficiaries Age 65 to 74 | 728 |
| Number Of Beneficiaries Age 75 to 84 | 666 |
| Number Of Beneficiaries Age Greater 84 | 497 |
| Number Of Female Beneficiaries | 1535 |
| Number Of Male Beneficiaries | 693 |
| Number Of Non Hispanic White Beneficiaries | 1978 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 123 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 567 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6136 |