| National Provider Identifier [NPI]: | 1790935153 |
| Last Name Of The Provider | TELIVALA |
| First Name Of The Provider | BIJOY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1235 SAN MARCO BLVD |
| Street Address 2 Of The Provider | SUITE 202 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322078554 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 255653 |
| Number Of Medicare Beneficiaries | 695 |
| Total Submitted Charge Amount | 7018507 |
| Total Medicare Allowed Amount | 2693047.86 |
| Total Medicare Payment Amount | 2107540.77 |
| Total Medicare Standardized Payment Amount | 2096932.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 61 |
| Number Of Drug Services | 245958 |
| Number Of Medicare Beneficiaries With Drug Services | 172 |
| Total Drug Submitted ChargeAmount | 5760245 |
| Total Drug Medicare AllowedAmount | 2134562.87 |
| Total Drug Medicare PaymentAmount | 1671627.19 |
| Total Drug Medicare Standardized Payment Amount | 1671627.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 9695 |
| Number Of Medicare Beneficiaries With Medical Services | 695 |
| Total Medical Submitted Charge Amount | 1258262 |
| Total Medical Medicare Allowed Amount | 558484.99 |
| Total Medical Medicare Payment Amount | 435913.58 |
| Total Medical Medicare Standardized Payment Amount | 425305.39 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 126 |
| Number Of Beneficiaries Age 65 to 74 | 302 |
| Number Of Beneficiaries Age 75 to 84 | 188 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 382 |
| Number Of Male Beneficiaries | 313 |
| Number Of Non Hispanic White Beneficiaries | 514 |
| Number Of Black or African American Beneficiaries | 156 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 558 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 137 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.384 |