| National Provider Identifier [NPI]: | 1780619700 |
| Last Name Of The Provider | TIFFANY |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3 WOODLAND RD |
| Street Address 2 Of The Provider | SUITE 216 |
| City Of The Provider | STONEHAM |
| Zip Code Of The Provider | 021801702 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 1626 |
| Number Of Medicare Beneficiaries | 636 |
| Total Submitted Charge Amount | 1165496 |
| Total Medicare Allowed Amount | 224375.86 |
| Total Medicare Payment Amount | 170798.77 |
| Total Medicare Standardized Payment Amount | 160187.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 195 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 222944 |
| Total Drug Medicare AllowedAmount | 28252.11 |
| Total Drug Medicare PaymentAmount | 22124.98 |
| Total Drug Medicare Standardized Payment Amount | 22124.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 76 |
| Number Of Medical Services | 1431 |
| Number Of Medicare Beneficiaries With Medical Services | 636 |
| Total Medical Submitted Charge Amount | 942552 |
| Total Medical Medicare Allowed Amount | 196123.75 |
| Total Medical Medicare Payment Amount | 148673.79 |
| Total Medical Medicare Standardized Payment Amount | 138062.19 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 271 |
| Number Of Beneficiaries Age 75 to 84 | 229 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 525 |
| Number Of Non Hispanic White Beneficiaries | 606 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 585 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 51 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 32 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1523 |