| National Provider Identifier [NPI]: | 1164469813 |
| Last Name Of The Provider | UDELSON |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 750 WASHINGTON ST |
| Street Address 2 Of The Provider | NEW ENGLAND MEDICAL CTR |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 021111526 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 1462 |
| Number Of Medicare Beneficiaries | 891 |
| Total Submitted Charge Amount | 201911 |
| Total Medicare Allowed Amount | 73388.93 |
| Total Medicare Payment Amount | 55395.11 |
| Total Medicare Standardized Payment Amount | 53300.2 |
| 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 | 21 |
| Number Of Medical Services | 1462 |
| Number Of Medicare Beneficiaries With Medical Services | 891 |
| Total Medical Submitted Charge Amount | 201911 |
| Total Medical Medicare Allowed Amount | 73388.93 |
| Total Medical Medicare Payment Amount | 55395.11 |
| Total Medical Medicare Standardized Payment Amount | 53300.2 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 219 |
| Number Of Beneficiaries Age 65 to 74 | 344 |
| Number Of Beneficiaries Age 75 to 84 | 239 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 376 |
| Number Of Male Beneficiaries | 515 |
| Number Of Non Hispanic White Beneficiaries | 669 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | 83 |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 560 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 331 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.1997 |