| National Provider Identifier [NPI]: | 1396882536 |
| Last Name Of The Provider | MEDAGODA |
| First Name Of The Provider | RUMALI |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9311 S MINGO ROAD |
| Street Address 2 Of The Provider | THE ALLERGY CLINIC OF TULSA |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741335702 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Allergy/Immunology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 5692 |
| Number Of Medicare Beneficiaries | 409 |
| Total Submitted Charge Amount | 153324.15 |
| Total Medicare Allowed Amount | 95229.62 |
| Total Medicare Payment Amount | 66074.35 |
| Total Medicare Standardized Payment Amount | 66930.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 1847 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 70139.55 |
| Total Drug Medicare AllowedAmount | 50767.8 |
| Total Drug Medicare PaymentAmount | 33786.76 |
| Total Drug Medicare Standardized Payment Amount | 33786.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 3845 |
| Number Of Medicare Beneficiaries With Medical Services | 409 |
| Total Medical Submitted Charge Amount | 83184.6 |
| Total Medical Medicare Allowed Amount | 44461.82 |
| Total Medical Medicare Payment Amount | 32287.59 |
| Total Medical Medicare Standardized Payment Amount | 33143.43 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 253 |
| Number Of Beneficiaries Age 75 to 84 | 82 |
| Number Of Beneficiaries Age Greater 84 | 13 |
| Number Of Female Beneficiaries | 272 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 347 |
| Number Of Black or African American Beneficiaries | 23 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 370 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 30 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 9 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8002 |