| National Provider Identifier [NPI]: | 1437260999 |
| Last Name Of The Provider | STOCKMAN |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | LICSW |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 75 LINDALL ST |
| Street Address 2 Of The Provider | CENTER FOR HEALTHY AGING |
| City Of The Provider | DANVERS |
| Zip Code Of The Provider | 019232121 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Licensed Clinical Social Worker |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 3 |
| Number Of Services | 695 |
| Number Of Medicare Beneficiaries | 261 |
| Total Submitted Charge Amount | 64029 |
| Total Medicare Allowed Amount | 43512.43 |
| Total Medicare Payment Amount | 32072.48 |
| Total Medicare Standardized Payment Amount | 31722.95 |
| 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 | 695 |
| Number Of Medicare Beneficiaries With Medical Services | 261 |
| Total Medical Submitted Charge Amount | 64029 |
| Total Medical Medicare Allowed Amount | 43512.43 |
| Total Medical Medicare Payment Amount | 32072.48 |
| Total Medical Medicare Standardized Payment Amount | 31722.95 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 81 |
| Number Of Beneficiaries Age 75 to 84 | 109 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 179 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 249 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 202 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 48 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 72 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4047 |