| National Provider Identifier [NPI]: | 1700843919 |
| Last Name Of The Provider | PETRILLO-BOLANOS |
| First Name Of The Provider | MARIARITA |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 237A STATE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DARTMOUTH |
| Zip Code Of The Provider | 027472612 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 3738 |
| Number Of Medicare Beneficiaries | 1169 |
| Total Submitted Charge Amount | 458224.2 |
| Total Medicare Allowed Amount | 146653.46 |
| Total Medicare Payment Amount | 107774.53 |
| Total Medicare Standardized Payment Amount | 106826.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 188 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 5151.2 |
| Total Drug Medicare AllowedAmount | 835.07 |
| Total Drug Medicare PaymentAmount | 609 |
| Total Drug Medicare Standardized Payment Amount | 609 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 115 |
| Number Of Medical Services | 3550 |
| Number Of Medicare Beneficiaries With Medical Services | 1169 |
| Total Medical Submitted Charge Amount | 453073 |
| Total Medical Medicare Allowed Amount | 145818.39 |
| Total Medical Medicare Payment Amount | 107165.53 |
| Total Medical Medicare Standardized Payment Amount | 106217.12 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 264 |
| Number Of Beneficiaries Age 65 to 74 | 450 |
| Number Of Beneficiaries Age 75 to 84 | 291 |
| Number Of Beneficiaries Age Greater 84 | 164 |
| Number Of Female Beneficiaries | 733 |
| Number Of Male Beneficiaries | 436 |
| Number Of Non Hispanic White Beneficiaries | 1012 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 87 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 793 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 376 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1678 |