| National Provider Identifier [NPI]: | 1346445624 |
| Last Name Of The Provider | MENON |
| First Name Of The Provider | PREMA |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 COLCHESTER AVE |
| Street Address 2 Of The Provider | PULMONARY AND CRITICAL CARE DIVISION FAHC |
| City Of The Provider | BURLINGTON |
| Zip Code Of The Provider | 054053421 |
| State Code Of The Provider | VT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Critical Care (Intensivists) |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 305 |
| Number Of Medicare Beneficiaries | 173 |
| Total Submitted Charge Amount | 157051 |
| Total Medicare Allowed Amount | 36250.8 |
| Total Medicare Payment Amount | 28301.03 |
| Total Medicare Standardized Payment Amount | 28920.53 |
| 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 | 25 |
| Number Of Medical Services | 305 |
| Number Of Medicare Beneficiaries With Medical Services | 173 |
| Total Medical Submitted Charge Amount | 157051 |
| Total Medical Medicare Allowed Amount | 36250.8 |
| Total Medical Medicare Payment Amount | 28301.03 |
| Total Medical Medicare Standardized Payment Amount | 28920.53 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 87 |
| 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 | 115 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 34 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9517 |