| National Provider Identifier [NPI]: | 1104067966 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D., PH.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 BROOKLINE AVE |
| Street Address 2 Of The Provider | BETH ISRAEL DEACONESS MEDICAL CENTER |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022155400 |
| 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 | 160 |
| Number Of Services | 5271 |
| Number Of Medicare Beneficiaries | 3396 |
| Total Submitted Charge Amount | 463073 |
| Total Medicare Allowed Amount | 150275.65 |
| Total Medicare Payment Amount | 111463.5 |
| Total Medicare Standardized Payment Amount | 111232.41 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 722 |
| Number Of Beneficiaries Age 65 to 74 | 1102 |
| Number Of Beneficiaries Age 75 to 84 | 879 |
| Number Of Beneficiaries Age Greater 84 | 693 |
| Number Of Female Beneficiaries | 1987 |
| Number Of Male Beneficiaries | 1409 |
| Number Of Non Hispanic White Beneficiaries | 2802 |
| Number Of Black or African American Beneficiaries | 300 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 159 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 71 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2205 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1191 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8532 |