| National Provider Identifier [NPI]: | 1497080048 |
| Last Name Of The Provider | TELLO |
| First Name Of The Provider | JORGE |
| 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 | 294 WASHINGTON ST |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021084634 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 474 |
| Number Of Medicare Beneficiaries | 141 |
| Total Submitted Charge Amount | 158112 |
| Total Medicare Allowed Amount | 49023.63 |
| Total Medicare Payment Amount | 35697.51 |
| Total Medicare Standardized Payment Amount | 34108.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1218 |
| Total Drug Medicare AllowedAmount | 896.34 |
| Total Drug Medicare PaymentAmount | 871.86 |
| Total Drug Medicare Standardized Payment Amount | 871.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 452 |
| Number Of Medicare Beneficiaries With Medical Services | 141 |
| Total Medical Submitted Charge Amount | 156894 |
| Total Medical Medicare Allowed Amount | 48127.29 |
| Total Medical Medicare Payment Amount | 34825.65 |
| Total Medical Medicare Standardized Payment Amount | 33236.97 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 63 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 74 |
| Number Of Male Beneficiaries | 67 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 87 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 23 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0854 |