| National Provider Identifier [NPI]: | 1124016118 |
| Last Name Of The Provider | PELLETIER |
| First Name Of The Provider | TARA |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 FODEN ROAD EAST |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | SOUTH PORTLAND |
| Zip Code Of The Provider | 04106 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 1174 |
| Number Of Medicare Beneficiaries | 73 |
| Total Submitted Charge Amount | 68423 |
| Total Medicare Allowed Amount | 31878.12 |
| Total Medicare Payment Amount | 25739.55 |
| Total Medicare Standardized Payment Amount | 26075.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 242 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 2328 |
| Total Drug Medicare AllowedAmount | 1876.17 |
| Total Drug Medicare PaymentAmount | 1827.89 |
| Total Drug Medicare Standardized Payment Amount | 1827.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 932 |
| Number Of Medicare Beneficiaries With Medical Services | 73 |
| Total Medical Submitted Charge Amount | 66095 |
| Total Medical Medicare Allowed Amount | 30001.95 |
| Total Medical Medicare Payment Amount | 23911.66 |
| Total Medical Medicare Standardized Payment Amount | 24247.16 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 58 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 19 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7706 |