| National Provider Identifier [NPI]: | 1629394127 |
| Last Name Of The Provider | THOTTAPPILLY |
| First Name Of The Provider | LISA |
| 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 | 1010 S SCHEUBER RD STE 3&4 |
| Street Address 2 Of The Provider | PMG SW WA CENTRALIA INT MED |
| City Of The Provider | CENTRALIA |
| Zip Code Of The Provider | 985318892 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 533 |
| Number Of Medicare Beneficiaries | 143 |
| Total Submitted Charge Amount | 100796.08 |
| Total Medicare Allowed Amount | 40786.34 |
| Total Medicare Payment Amount | 27660.62 |
| Total Medicare Standardized Payment Amount | 29471.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1111.08 |
| Total Drug Medicare AllowedAmount | 1090.52 |
| Total Drug Medicare PaymentAmount | 1066.07 |
| Total Drug Medicare Standardized Payment Amount | 1066.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 23 |
| Number Of Medical Services | 491 |
| Number Of Medicare Beneficiaries With Medical Services | 143 |
| Total Medical Submitted Charge Amount | 99685 |
| Total Medical Medicare Allowed Amount | 39695.82 |
| Total Medical Medicare Payment Amount | 26594.55 |
| Total Medical Medicare Standardized Payment Amount | 28405.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 99 |
| Number Of Male Beneficiaries | 44 |
| Number Of Non Hispanic White Beneficiaries | 132 |
| 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 | 116 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0172 |