| National Provider Identifier [NPI]: | 1477572816 |
| Last Name Of The Provider | KUPERMAN-BEADE |
| First Name Of The Provider | MARINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D., F.A.A.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 RANDALL SQ |
| Street Address 2 Of The Provider | SUITE 306 |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029042709 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 2216 |
| Number Of Medicare Beneficiaries | 526 |
| Total Submitted Charge Amount | 1168122.9 |
| Total Medicare Allowed Amount | 667902.19 |
| Total Medicare Payment Amount | 516559.45 |
| Total Medicare Standardized Payment Amount | 480204.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 20 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 6195 |
| Total Drug Medicare AllowedAmount | 4124.41 |
| Total Drug Medicare PaymentAmount | 3233.49 |
| Total Drug Medicare Standardized Payment Amount | 3233.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 2196 |
| Number Of Medicare Beneficiaries With Medical Services | 526 |
| Total Medical Submitted Charge Amount | 1161927.9 |
| Total Medical Medicare Allowed Amount | 663777.78 |
| Total Medical Medicare Payment Amount | 513325.96 |
| Total Medical Medicare Standardized Payment Amount | 476971.48 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 176 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 265 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | 509 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 501 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1295 |