| National Provider Identifier [NPI]: | 1932549979 |
| Last Name Of The Provider | BOUTHILLIER |
| First Name Of The Provider | MELANIE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16 WILLIAM F PALMER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOODUS |
| Zip Code Of The Provider | 064691195 |
| 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 | 29 |
| Number Of Services | 395 |
| Number Of Medicare Beneficiaries | 130 |
| Total Submitted Charge Amount | 41397.6 |
| Total Medicare Allowed Amount | 20535.83 |
| Total Medicare Payment Amount | 16094.54 |
| Total Medicare Standardized Payment Amount | 17507.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 23 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 686 |
| Total Drug Medicare AllowedAmount | 458.88 |
| Total Drug Medicare PaymentAmount | 449.63 |
| Total Drug Medicare Standardized Payment Amount | 449.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 372 |
| Number Of Medicare Beneficiaries With Medical Services | 130 |
| Total Medical Submitted Charge Amount | 40711.6 |
| Total Medical Medicare Allowed Amount | 20076.95 |
| Total Medical Medicare Payment Amount | 15644.91 |
| Total Medical Medicare Standardized Payment Amount | 17057.79 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 46 |
| Number Of Beneficiaries Age 75 to 84 | 41 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 80 |
| Number Of Male Beneficiaries | 50 |
| 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 | 99 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0338 |