| National Provider Identifier [NPI]: | 1457579559 |
| Last Name Of The Provider | WASSER |
| First Name Of The Provider | ELLIOT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 593 EDDY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029034923 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 152 |
| Number Of Services | 9760 |
| Number Of Medicare Beneficiaries | 1801 |
| Total Submitted Charge Amount | 977202.23 |
| Total Medicare Allowed Amount | 199189.27 |
| Total Medicare Payment Amount | 148128.88 |
| Total Medicare Standardized Payment Amount | 143576.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 7050 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 11700 |
| Total Drug Medicare AllowedAmount | 1331.65 |
| Total Drug Medicare PaymentAmount | 1043.85 |
| Total Drug Medicare Standardized Payment Amount | 1043.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 2710 |
| Number Of Medicare Beneficiaries With Medical Services | 1800 |
| Total Medical Submitted Charge Amount | 965502.23 |
| Total Medical Medicare Allowed Amount | 197857.62 |
| Total Medical Medicare Payment Amount | 147085.03 |
| Total Medical Medicare Standardized Payment Amount | 142532.45 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 815 |
| Number Of Beneficiaries Age 75 to 84 | 572 |
| Number Of Beneficiaries Age Greater 84 | 213 |
| Number Of Female Beneficiaries | 940 |
| Number Of Male Beneficiaries | 861 |
| Number Of Non Hispanic White Beneficiaries | 1311 |
| Number Of Black or African American Beneficiaries | 163 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 260 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1536 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 265 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.8088 |