| National Provider Identifier [NPI]: | 1659398501 |
| Last Name Of The Provider | LUSTGARTEN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | L |
| 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 | 111 COLCHESTER AVE |
| Street Address 2 Of The Provider | MCCLURE 1 CARDIOLOGY |
| City Of The Provider | BURLINGTON |
| Zip Code Of The Provider | 054011473 |
| State Code Of The Provider | VT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Electrophysiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 1825 |
| Number Of Medicare Beneficiaries | 1263 |
| Total Submitted Charge Amount | 826250 |
| Total Medicare Allowed Amount | 160480 |
| Total Medicare Payment Amount | 123985.63 |
| Total Medicare Standardized Payment Amount | 128955.48 |
| 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 | 73 |
| Number Of Medical Services | 1825 |
| Number Of Medicare Beneficiaries With Medical Services | 1263 |
| Total Medical Submitted Charge Amount | 826250 |
| Total Medical Medicare Allowed Amount | 160480 |
| Total Medical Medicare Payment Amount | 123985.63 |
| Total Medical Medicare Standardized Payment Amount | 128955.48 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 150 |
| Number Of Beneficiaries Age 65 to 74 | 429 |
| Number Of Beneficiaries Age 75 to 84 | 456 |
| Number Of Beneficiaries Age Greater 84 | 228 |
| Number Of Female Beneficiaries | 585 |
| Number Of Male Beneficiaries | 678 |
| Number Of Non Hispanic White Beneficiaries | 1215 |
| Number Of Black or African American Beneficiaries | 13 |
| 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 | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 965 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 298 |
| Percent Of With Atrial Fibrillation | 42 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5814 |