| National Provider Identifier [NPI]: | 1932408002 |
| Last Name Of The Provider | BELANGER |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 FRUIT ST |
| Street Address 2 Of The Provider | COX 630 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021142621 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 594 |
| Number Of Medicare Beneficiaries | 115 |
| Total Submitted Charge Amount | 57337 |
| Total Medicare Allowed Amount | 20654.65 |
| Total Medicare Payment Amount | 15883.33 |
| Total Medicare Standardized Payment Amount | 17375.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 355 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 6261 |
| Total Drug Medicare AllowedAmount | 3965.88 |
| Total Drug Medicare PaymentAmount | 3109.3 |
| Total Drug Medicare Standardized Payment Amount | 3109.3 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 239 |
| Number Of Medicare Beneficiaries With Medical Services | 115 |
| Total Medical Submitted Charge Amount | 51076 |
| Total Medical Medicare Allowed Amount | 16688.77 |
| Total Medical Medicare Payment Amount | 12774.03 |
| Total Medical Medicare Standardized Payment Amount | 14265.77 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 37 |
| Number Of Beneficiaries Age 75 to 84 | 39 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 76 |
| Number Of Male Beneficiaries | 39 |
| 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 | 89 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 68 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2256 |