| National Provider Identifier [NPI]: | 1124088844 |
| Last Name Of The Provider | CLANCY |
| First Name Of The Provider | JANE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 40 HOLLAND ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOMERVILLE |
| Zip Code Of The Provider | 021442705 |
| 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 | 79 |
| Number Of Services | 3770 |
| Number Of Medicare Beneficiaries | 2768 |
| Total Submitted Charge Amount | 286952 |
| Total Medicare Allowed Amount | 188120.06 |
| Total Medicare Payment Amount | 146017.96 |
| Total Medicare Standardized Payment Amount | 132025.88 |
| 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 | 79 |
| Number Of Medical Services | 3770 |
| Number Of Medicare Beneficiaries With Medical Services | 2768 |
| Total Medical Submitted Charge Amount | 286952 |
| Total Medical Medicare Allowed Amount | 188120.06 |
| Total Medical Medicare Payment Amount | 146017.96 |
| Total Medical Medicare Standardized Payment Amount | 132025.88 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 339 |
| Number Of Beneficiaries Age 65 to 74 | 1384 |
| Number Of Beneficiaries Age 75 to 84 | 747 |
| Number Of Beneficiaries Age Greater 84 | 298 |
| Number Of Female Beneficiaries | 1847 |
| Number Of Male Beneficiaries | 921 |
| Number Of Non Hispanic White Beneficiaries | 2350 |
| Number Of Black or African American Beneficiaries | 206 |
| Number Of AsianPacific Islander Beneficiaries | 63 |
| Number Of Hispanic Beneficiaries | 68 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 81 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 497 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0887 |