| National Provider Identifier [NPI]: | 1285833608 |
| Last Name Of The Provider | MEHTA |
| First Name Of The Provider | DIVYANG |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEBSTER |
| Zip Code Of The Provider | 775984219 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Radiation Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 55 |
| Number Of Services | 4494 |
| Number Of Medicare Beneficiaries | 92 |
| Total Submitted Charge Amount | 3268021 |
| Total Medicare Allowed Amount | 661962.96 |
| Total Medicare Payment Amount | 517923.61 |
| Total Medicare Standardized Payment Amount | 503302.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1010 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 13360 |
| Total Drug Medicare AllowedAmount | 2481.57 |
| Total Drug Medicare PaymentAmount | 1945.59 |
| Total Drug Medicare Standardized Payment Amount | 1945.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 3484 |
| Number Of Medicare Beneficiaries With Medical Services | 92 |
| Total Medical Submitted Charge Amount | 3254661 |
| Total Medical Medicare Allowed Amount | 659481.39 |
| Total Medical Medicare Payment Amount | 515978.02 |
| Total Medical Medicare Standardized Payment Amount | 501357.24 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 52 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 47 |
| Number Of Non Hispanic White Beneficiaries | 72 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 75 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7599 |