| National Provider Identifier [NPI]: | 1205964426 |
| Last Name Of The Provider | CICCONE |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 WASHINGTON ST |
| Street Address 2 Of The Provider | GENERATIONS FAMILY HEALTH CENTER |
| City Of The Provider | NORWICH |
| Zip Code Of The Provider | 063602700 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 1167 |
| Number Of Medicare Beneficiaries | 472 |
| Total Submitted Charge Amount | 216930 |
| Total Medicare Allowed Amount | 98210.43 |
| Total Medicare Payment Amount | 76243.29 |
| Total Medicare Standardized Payment Amount | 85294.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 1167 |
| Number Of Medicare Beneficiaries With Medical Services | 472 |
| Total Medical Submitted Charge Amount | 216930 |
| Total Medical Medicare Allowed Amount | 98210.43 |
| Total Medical Medicare Payment Amount | 76243.29 |
| Total Medical Medicare Standardized Payment Amount | 85294.83 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 100 |
| Number Of Beneficiaries Age 75 to 84 | 150 |
| Number Of Beneficiaries Age Greater 84 | 142 |
| Number Of Female Beneficiaries | 282 |
| Number Of Male Beneficiaries | 190 |
| Number Of Non Hispanic White Beneficiaries | 398 |
| Number Of Black or African American Beneficiaries | 36 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 284 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 188 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 33 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 2.1657 |