| National Provider Identifier [NPI]: | 1821142191 |
| Last Name Of The Provider | LEMOS |
| First Name Of The Provider | DIEGO |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.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 | FAHC-MCHV CAMPUS PATRICK 1 ROOM 117 |
| 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 | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 3457 |
| Number Of Medicare Beneficiaries | 2097 |
| Total Submitted Charge Amount | 479025 |
| Total Medicare Allowed Amount | 68560.12 |
| Total Medicare Payment Amount | 50157.08 |
| Total Medicare Standardized Payment Amount | 51133.54 |
| 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 | 81 |
| Number Of Medical Services | 3457 |
| Number Of Medicare Beneficiaries With Medical Services | 2097 |
| Total Medical Submitted Charge Amount | 479025 |
| Total Medical Medicare Allowed Amount | 68560.12 |
| Total Medical Medicare Payment Amount | 50157.08 |
| Total Medical Medicare Standardized Payment Amount | 51133.54 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 387 |
| Number Of Beneficiaries Age 65 to 74 | 892 |
| Number Of Beneficiaries Age 75 to 84 | 583 |
| Number Of Beneficiaries Age Greater 84 | 235 |
| Number Of Female Beneficiaries | 1259 |
| Number Of Male Beneficiaries | 838 |
| Number Of Non Hispanic White Beneficiaries | 2005 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 49 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1583 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 514 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 66 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1971 |