| National Provider Identifier [NPI]: | 1336113992 |
| Last Name Of The Provider | BALAMUNISWAMY |
| First Name Of The Provider | LATHA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 19TH AVE |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | MOLINE |
| Zip Code Of The Provider | 612653700 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 477 |
| Number Of Medicare Beneficiaries | 318 |
| Total Submitted Charge Amount | 54048 |
| Total Medicare Allowed Amount | 29648.16 |
| Total Medicare Payment Amount | 18373.32 |
| Total Medicare Standardized Payment Amount | 19859.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 25 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 407 |
| Total Drug Medicare AllowedAmount | 176.2 |
| Total Drug Medicare PaymentAmount | 155.6 |
| Total Drug Medicare Standardized Payment Amount | 155.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 452 |
| Number Of Medicare Beneficiaries With Medical Services | 318 |
| Total Medical Submitted Charge Amount | 53641 |
| Total Medical Medicare Allowed Amount | 29471.96 |
| Total Medical Medicare Payment Amount | 18217.72 |
| Total Medical Medicare Standardized Payment Amount | 19703.85 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 66 |
| Number Of Beneficiaries Age 65 to 74 | 136 |
| Number Of Beneficiaries Age 75 to 84 | 81 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 194 |
| Number Of Male Beneficiaries | 124 |
| Number Of Non Hispanic White Beneficiaries | 281 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9659 |