| National Provider Identifier [NPI]: | 1144268459 |
| Last Name Of The Provider | GROSS |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 BROOKLINE AVENUE |
| Street Address 2 Of The Provider | BETH ISRAEL DEACONESS |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 02215 |
| 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 | 16 |
| Number Of Services | 2993 |
| Number Of Medicare Beneficiaries | 1416 |
| Total Submitted Charge Amount | 280640 |
| Total Medicare Allowed Amount | 93299.38 |
| Total Medicare Payment Amount | 83658.86 |
| Total Medicare Standardized Payment Amount | 80695.12 |
| 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 | 16 |
| Number Of Medical Services | 2993 |
| Number Of Medicare Beneficiaries With Medical Services | 1416 |
| Total Medical Submitted Charge Amount | 280640 |
| Total Medical Medicare Allowed Amount | 93299.38 |
| Total Medical Medicare Payment Amount | 83658.86 |
| Total Medical Medicare Standardized Payment Amount | 80695.12 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 849 |
| Number Of Beneficiaries Age 75 to 84 | 350 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 1177 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 62 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1147 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 269 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 50 |
| Percent Of With Ischemic Heart Disease | 13 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 1 |
| Average HCC Risk Score Of Beneficiaries | 0.8233 |