| National Provider Identifier [NPI]: | 1174596902 |
| Last Name Of The Provider | MAITEM |
| First Name Of The Provider | AVELINO |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 148 EAST AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORWALK |
| Zip Code Of The Provider | 068515721 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 120 |
| Number Of Services | 2148 |
| Number Of Medicare Beneficiaries | 1278 |
| Total Submitted Charge Amount | 160699 |
| Total Medicare Allowed Amount | 42001.94 |
| Total Medicare Payment Amount | 32021.75 |
| Total Medicare Standardized Payment Amount | 30366.23 |
| 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 | 120 |
| Number Of Medical Services | 2148 |
| Number Of Medicare Beneficiaries With Medical Services | 1278 |
| Total Medical Submitted Charge Amount | 160699 |
| Total Medical Medicare Allowed Amount | 42001.94 |
| Total Medical Medicare Payment Amount | 32021.75 |
| Total Medical Medicare Standardized Payment Amount | 30366.23 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 324 |
| Number Of Beneficiaries Age 75 to 84 | 384 |
| Number Of Beneficiaries Age Greater 84 | 424 |
| Number Of Female Beneficiaries | 735 |
| Number Of Male Beneficiaries | 543 |
| Number Of Non Hispanic White Beneficiaries | 1035 |
| Number Of Black or African American Beneficiaries | 135 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 72 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 874 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 404 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9829 |