| National Provider Identifier [NPI]: | 1457516270 |
| Last Name Of The Provider | THACHET |
| First Name Of The Provider | SIBIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 800 WASHINGTON STREET |
| Street Address 2 Of The Provider | BOX# 299 |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 02111 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 186 |
| Number Of Services | 11472.5 |
| Number Of Medicare Beneficiaries | 2155 |
| Total Submitted Charge Amount | 1015091.62 |
| Total Medicare Allowed Amount | 301128.89 |
| Total Medicare Payment Amount | 237339.03 |
| Total Medicare Standardized Payment Amount | 212307.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 7724.5 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 5156.83 |
| Total Drug Medicare AllowedAmount | 2269.7 |
| Total Drug Medicare PaymentAmount | 1779.46 |
| Total Drug Medicare Standardized Payment Amount | 1779.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 183 |
| Number Of Medical Services | 3748 |
| Number Of Medicare Beneficiaries With Medical Services | 2155 |
| Total Medical Submitted Charge Amount | 1009934.79 |
| Total Medical Medicare Allowed Amount | 298859.19 |
| Total Medical Medicare Payment Amount | 235559.57 |
| Total Medical Medicare Standardized Payment Amount | 210527.55 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 270 |
| Number Of Beneficiaries Age 65 to 74 | 810 |
| Number Of Beneficiaries Age 75 to 84 | 650 |
| Number Of Beneficiaries Age Greater 84 | 425 |
| Number Of Female Beneficiaries | 1321 |
| Number Of Male Beneficiaries | 834 |
| Number Of Non Hispanic White Beneficiaries | 1722 |
| Number Of Black or African American Beneficiaries | 210 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 132 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1580 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 575 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7728 |