| National Provider Identifier [NPI]: | 1871830414 |
| Last Name Of The Provider | BREEN |
| First Name Of The Provider | JESSICA |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 444 MONTGOMERY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICOPEE |
| Zip Code Of The Provider | 010201969 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 441 |
| Number Of Medicare Beneficiaries | 149 |
| Total Submitted Charge Amount | 62298.27 |
| Total Medicare Allowed Amount | 21940.82 |
| Total Medicare Payment Amount | 16955.46 |
| Total Medicare Standardized Payment Amount | 19352.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 1892.51 |
| Total Drug Medicare AllowedAmount | 943.61 |
| Total Drug Medicare PaymentAmount | 919.97 |
| Total Drug Medicare Standardized Payment Amount | 919.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 407 |
| Number Of Medicare Beneficiaries With Medical Services | 149 |
| Total Medical Submitted Charge Amount | 60405.76 |
| Total Medical Medicare Allowed Amount | 20997.21 |
| Total Medical Medicare Payment Amount | 16035.49 |
| Total Medical Medicare Standardized Payment Amount | 18432.08 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 84 |
| Number Of Male Beneficiaries | 65 |
| Number Of Non Hispanic White Beneficiaries | 122 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 97 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 52 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2913 |