| National Provider Identifier [NPI]: | 1174724264 |
| Last Name Of The Provider | IVANOVA |
| First Name Of The Provider | MILENA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 41 MALL RD |
| Street Address 2 Of The Provider | LAHEY HOSPITAL AND MEDICAL CENTER |
| City Of The Provider | BURLINGTON |
| Zip Code Of The Provider | 018050001 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 2826 |
| Number Of Medicare Beneficiaries | 1458 |
| Total Submitted Charge Amount | 282005 |
| Total Medicare Allowed Amount | 90375.7 |
| Total Medicare Payment Amount | 82202.25 |
| Total Medicare Standardized Payment Amount | 77436.71 |
| 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 | 58 |
| Number Of Medical Services | 2826 |
| Number Of Medicare Beneficiaries With Medical Services | 1458 |
| Total Medical Submitted Charge Amount | 282005 |
| Total Medical Medicare Allowed Amount | 90375.7 |
| Total Medical Medicare Payment Amount | 82202.25 |
| Total Medical Medicare Standardized Payment Amount | 77436.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 674 |
| Number Of Beneficiaries Age 75 to 84 | 481 |
| Number Of Beneficiaries Age Greater 84 | 165 |
| Number Of Female Beneficiaries | 1330 |
| Number Of Male Beneficiaries | 128 |
| Number Of Non Hispanic White Beneficiaries | 1364 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1292 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 166 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9835 |