| National Provider Identifier [NPI]: | 1003840836 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | GAIL |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | SOUTH COVE COMM HEALTH CTR |
| Street Address 2 Of The Provider | 885 WASHINGTON ST |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 02111 |
| 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 | 10 |
| Number Of Services | 266 |
| Number Of Medicare Beneficiaries | 105 |
| Total Submitted Charge Amount | 10170.36 |
| Total Medicare Allowed Amount | 4282.64 |
| Total Medicare Payment Amount | 3498.07 |
| Total Medicare Standardized Payment Amount | 3297.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 41 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 1431.36 |
| Total Drug Medicare AllowedAmount | 1117.49 |
| Total Drug Medicare PaymentAmount | 1055.96 |
| Total Drug Medicare Standardized Payment Amount | 1055.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 7 |
| Number Of Medical Services | 225 |
| Number Of Medicare Beneficiaries With Medical Services | 105 |
| Total Medical Submitted Charge Amount | 8739 |
| Total Medical Medicare Allowed Amount | 3165.15 |
| Total Medical Medicare Payment Amount | 2442.11 |
| Total Medical Medicare Standardized Payment Amount | 2241.88 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 68 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 16 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0532 |