| National Provider Identifier [NPI]: | 1467625228 |
| Last Name Of The Provider | COSTA |
| First Name Of The Provider | GERALD |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | C.R.N.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 BERKSHIRE SQ |
| Street Address 2 Of The Provider | |
| City Of The Provider | ADAMS |
| Zip Code Of The Provider | 012201300 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 3 |
| Number Of Services | 996 |
| Number Of Medicare Beneficiaries | 854 |
| Total Submitted Charge Amount | 1066496 |
| Total Medicare Allowed Amount | 177400.96 |
| Total Medicare Payment Amount | 137552.49 |
| Total Medicare Standardized Payment Amount | 138023.65 |
| 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 | 3 |
| Number Of Medical Services | 996 |
| Number Of Medicare Beneficiaries With Medical Services | 854 |
| Total Medical Submitted Charge Amount | 1066496 |
| Total Medical Medicare Allowed Amount | 177400.96 |
| Total Medical Medicare Payment Amount | 137552.49 |
| Total Medical Medicare Standardized Payment Amount | 138023.65 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 354 |
| Number Of Beneficiaries Age 75 to 84 | 340 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 496 |
| Number Of Male Beneficiaries | 358 |
| Number Of Non Hispanic White Beneficiaries | 768 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 703 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 151 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1148 |