| National Provider Identifier [NPI]: | 1104012715 |
| Last Name Of The Provider | TEITELBAUM |
| First Name Of The Provider | PHILIP |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8900 N. KENDALL DRIVE |
| Street Address 2 Of The Provider | CHILDREN'S HOSPITAL BOSTON |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331762118 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 5680 |
| Number Of Medicare Beneficiaries | 2049 |
| Total Submitted Charge Amount | 942387 |
| Total Medicare Allowed Amount | 113969.33 |
| Total Medicare Payment Amount | 86118.26 |
| Total Medicare Standardized Payment Amount | 81301.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 3185 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 15925 |
| Total Drug Medicare AllowedAmount | 588.26 |
| Total Drug Medicare PaymentAmount | 450.89 |
| Total Drug Medicare Standardized Payment Amount | 450.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 2495 |
| Number Of Medicare Beneficiaries With Medical Services | 2048 |
| Total Medical Submitted Charge Amount | 926462 |
| Total Medical Medicare Allowed Amount | 113381.07 |
| Total Medical Medicare Payment Amount | 85667.37 |
| Total Medical Medicare Standardized Payment Amount | 80850.54 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 285 |
| Number Of Beneficiaries Age 65 to 74 | 581 |
| Number Of Beneficiaries Age 75 to 84 | 658 |
| Number Of Beneficiaries Age Greater 84 | 525 |
| Number Of Female Beneficiaries | 1262 |
| Number Of Male Beneficiaries | 787 |
| Number Of Non Hispanic White Beneficiaries | 689 |
| Number Of Black or African American Beneficiaries | 135 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 1190 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 924 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1125 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 36 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.3511 |