| National Provider Identifier [NPI]: | 1891812061 |
| Last Name Of The Provider | DOVIDIO |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 555 TURNPIKE ST |
| Street Address 2 Of The Provider | STE 31 |
| City Of The Provider | NORTH ANDOVER |
| Zip Code Of The Provider | 018455923 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 440 |
| Number Of Medicare Beneficiaries | 133 |
| Total Submitted Charge Amount | 55698 |
| Total Medicare Allowed Amount | 16964.66 |
| Total Medicare Payment Amount | 11512.71 |
| Total Medicare Standardized Payment Amount | 13637.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 31 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1675 |
| Total Drug Medicare AllowedAmount | 174 |
| Total Drug Medicare PaymentAmount | 127.38 |
| Total Drug Medicare Standardized Payment Amount | 127.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 409 |
| Number Of Medicare Beneficiaries With Medical Services | 133 |
| Total Medical Submitted Charge Amount | 54023 |
| Total Medical Medicare Allowed Amount | 16790.66 |
| Total Medical Medicare Payment Amount | 11385.33 |
| Total Medical Medicare Standardized Payment Amount | 13510.36 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| 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 | 88 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0077 |