| National Provider Identifier [NPI]: | 1639121627 |
| Last Name Of The Provider | SRIDHAR |
| First Name Of The Provider | SHANTHY |
| 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 | 133 BROOKLINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022153904 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 1625 |
| Number Of Medicare Beneficiaries | 139 |
| Total Submitted Charge Amount | 65709.04 |
| Total Medicare Allowed Amount | 50436.34 |
| Total Medicare Payment Amount | 40730.06 |
| Total Medicare Standardized Payment Amount | 39021.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 74 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 3005.04 |
| Total Drug Medicare AllowedAmount | 1833.51 |
| Total Drug Medicare PaymentAmount | 1788.47 |
| Total Drug Medicare Standardized Payment Amount | 1788.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 1551 |
| Number Of Medicare Beneficiaries With Medical Services | 139 |
| Total Medical Submitted Charge Amount | 62704 |
| Total Medical Medicare Allowed Amount | 48602.83 |
| Total Medical Medicare Payment Amount | 38941.59 |
| Total Medical Medicare Standardized Payment Amount | 37233.22 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 89 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | 11 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | 47 |
| Number Of Black or African American Beneficiaries | 73 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 107 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0152 |