| National Provider Identifier [NPI]: | 1508854472 |
| Last Name Of The Provider | EVANGELISTA |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 20 CATAMORE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAST PROVIDENCE |
| Zip Code Of The Provider | 029141204 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 6507 |
| Number Of Medicare Beneficiaries | 2021 |
| Total Submitted Charge Amount | 595964.5 |
| Total Medicare Allowed Amount | 159528.19 |
| Total Medicare Payment Amount | 119116.05 |
| Total Medicare Standardized Payment Amount | 115881.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 3415 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 3074.5 |
| Total Drug Medicare AllowedAmount | 1121.49 |
| Total Drug Medicare PaymentAmount | 879.22 |
| Total Drug Medicare Standardized Payment Amount | 879.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 134 |
| Number Of Medical Services | 3092 |
| Number Of Medicare Beneficiaries With Medical Services | 2020 |
| Total Medical Submitted Charge Amount | 592890 |
| Total Medical Medicare Allowed Amount | 158406.7 |
| Total Medical Medicare Payment Amount | 118236.83 |
| Total Medical Medicare Standardized Payment Amount | 115002.27 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 468 |
| Number Of Beneficiaries Age 65 to 74 | 710 |
| Number Of Beneficiaries Age 75 to 84 | 526 |
| Number Of Beneficiaries Age Greater 84 | 317 |
| Number Of Female Beneficiaries | 1252 |
| Number Of Male Beneficiaries | 769 |
| Number Of Non Hispanic White Beneficiaries | 1632 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 203 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 59 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1312 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 709 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.57 |