| National Provider Identifier [NPI]: | 1356323646 |
| Last Name Of The Provider | STAFFA |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 FRUIT STREET |
| Street Address 2 Of The Provider | FND 2 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021142696 |
| 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 | 15 |
| Number Of Services | 3981 |
| Number Of Medicare Beneficiaries | 1898 |
| Total Submitted Charge Amount | 601736 |
| Total Medicare Allowed Amount | 160486.97 |
| Total Medicare Payment Amount | 149170.57 |
| Total Medicare Standardized Payment Amount | 137452.14 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 208 |
| Number Of Beneficiaries Age 65 to 74 | 1027 |
| Number Of Beneficiaries Age 75 to 84 | 539 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 1884 |
| Number Of Male Beneficiaries | 14 |
| Number Of Non Hispanic White Beneficiaries | 1645 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1562 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 336 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.9446 |