| National Provider Identifier [NPI]: | 1093047524 |
| Last Name Of The Provider | BEAUZILE |
| First Name Of The Provider | THEVENIN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 230 MAPLE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOLYOKE |
| Zip Code Of The Provider | 010405144 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 393 |
| Number Of Medicare Beneficiaries | 103 |
| Total Submitted Charge Amount | 9346 |
| Total Medicare Allowed Amount | 5707.32 |
| Total Medicare Payment Amount | 4451.49 |
| Total Medicare Standardized Payment Amount | 4609 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 555 |
| Total Drug Medicare AllowedAmount | 533.1 |
| Total Drug Medicare PaymentAmount | 522.38 |
| Total Drug Medicare Standardized Payment Amount | 522.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 364 |
| Number Of Medicare Beneficiaries With Medical Services | 102 |
| Total Medical Submitted Charge Amount | 8791 |
| Total Medical Medicare Allowed Amount | 5174.22 |
| Total Medical Medicare Payment Amount | 3929.11 |
| Total Medical Medicare Standardized Payment Amount | 4086.62 |
| Average Age Of Beneficiaries | 59 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 53 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 54 |
| 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 | 31 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 72 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1933 |