| National Provider Identifier [NPI]: | 1578514667 |
| Last Name Of The Provider | PENMETCHA |
| First Name Of The Provider | MOHAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2008 E HEBRON PKWY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | CARROLLTON |
| Zip Code Of The Provider | 750071602 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 31420 |
| Number Of Medicare Beneficiaries | 227 |
| Total Submitted Charge Amount | 1533585.47 |
| Total Medicare Allowed Amount | 606359.65 |
| Total Medicare Payment Amount | 466940.01 |
| Total Medicare Standardized Payment Amount | 470270.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 29470 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 1176570.47 |
| Total Drug Medicare AllowedAmount | 494045.95 |
| Total Drug Medicare PaymentAmount | 387226.46 |
| Total Drug Medicare Standardized Payment Amount | 387226.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 1950 |
| Number Of Medicare Beneficiaries With Medical Services | 227 |
| Total Medical Submitted Charge Amount | 357015 |
| Total Medical Medicare Allowed Amount | 112313.7 |
| Total Medical Medicare Payment Amount | 79713.55 |
| Total Medical Medicare Standardized Payment Amount | 83043.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 169 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 156 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 178 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2756 |