| National Provider Identifier [NPI]: | 1063459386 |
| Last Name Of The Provider | HENNESSEY |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 330 BROOKLINE AVE. |
| Street Address 2 Of The Provider | BETH ISRAEL DEACONESS MEDICAL CENTER |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022154141 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 438 |
| Number Of Medicare Beneficiaries | 260 |
| Total Submitted Charge Amount | 139125 |
| Total Medicare Allowed Amount | 44563.02 |
| Total Medicare Payment Amount | 31694.85 |
| Total Medicare Standardized Payment Amount | 30711.51 |
| 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 | 14 |
| Number Of Medical Services | 438 |
| Number Of Medicare Beneficiaries With Medical Services | 260 |
| Total Medical Submitted Charge Amount | 139125 |
| Total Medical Medicare Allowed Amount | 44563.02 |
| Total Medical Medicare Payment Amount | 31694.85 |
| Total Medical Medicare Standardized Payment Amount | 30711.51 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 141 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 184 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 196 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 203 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1707 |