| National Provider Identifier [NPI]: | 1619996535 |
| Last Name Of The Provider | MAITRA |
| First Name Of The Provider | JENNIFER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3400 N DYSART RD |
| Street Address 2 Of The Provider | UNIT G-127 |
| City Of The Provider | AVONDALE |
| Zip Code Of The Provider | 853921003 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 656 |
| Number Of Medicare Beneficiaries | 164 |
| Total Submitted Charge Amount | 67720 |
| Total Medicare Allowed Amount | 47974.03 |
| Total Medicare Payment Amount | 35793.96 |
| Total Medicare Standardized Payment Amount | 36459.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 56 |
| Total Drug Submitted ChargeAmount | 3094 |
| Total Drug Medicare AllowedAmount | 2339.17 |
| Total Drug Medicare PaymentAmount | 2248.55 |
| Total Drug Medicare Standardized Payment Amount | 2248.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 32 |
| Number Of Medical Services | 585 |
| Number Of Medicare Beneficiaries With Medical Services | 164 |
| Total Medical Submitted Charge Amount | 64626 |
| Total Medical Medicare Allowed Amount | 45634.86 |
| Total Medical Medicare Payment Amount | 33545.41 |
| Total Medical Medicare Standardized Payment Amount | 34211.27 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 140 |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 15 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7964 |