| National Provider Identifier [NPI]: | 1942284591 |
| Last Name Of The Provider | DECOSTE |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 90 LIBBEY PKWY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | WEYMOUTH |
| Zip Code Of The Provider | 021893129 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 9768 |
| Number Of Medicare Beneficiaries | 1559 |
| Total Submitted Charge Amount | 1304011 |
| Total Medicare Allowed Amount | 579647.16 |
| Total Medicare Payment Amount | 424266.94 |
| Total Medicare Standardized Payment Amount | 388845.14 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 29276 |
| Total Drug Medicare AllowedAmount | 23971.57 |
| Total Drug Medicare PaymentAmount | 18793.4 |
| Total Drug Medicare Standardized Payment Amount | 18793.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 9660 |
| Number Of Medicare Beneficiaries With Medical Services | 1559 |
| Total Medical Submitted Charge Amount | 1274735 |
| Total Medical Medicare Allowed Amount | 555675.59 |
| Total Medical Medicare Payment Amount | 405473.54 |
| Total Medical Medicare Standardized Payment Amount | 370051.74 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 820 |
| Number Of Beneficiaries Age 75 to 84 | 490 |
| Number Of Beneficiaries Age Greater 84 | 212 |
| Number Of Female Beneficiaries | 1076 |
| Number Of Male Beneficiaries | 483 |
| Number Of Non Hispanic White Beneficiaries | 1517 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1512 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.951 |