National Provider Identifier [NPI]: |
1861503781 |
Last Name Of The Provider |
GORAYA |
First Name Of The Provider |
SAIMA |
Middle Initial Of The Provider |
T |
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
207 FLETCHER |
Street Address 2 Of The Provider |
|
City Of The Provider |
ANN ARBOR |
Zip Code Of The Provider |
481091050 |
State Code Of The Provider |
MI |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
49 |
Number Of Services |
167 |
Number Of Medicare Beneficiaries |
43 |
Total Submitted Charge Amount |
6395 |
Total Medicare Allowed Amount |
5617.78 |
Total Medicare Payment Amount |
4353.14 |
Total Medicare Standardized Payment Amount |
4319.69 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
4 |
Number Of Drug Services |
15 |
Number Of Medicare Beneficiaries With Drug Services |
14 |
Total Drug Submitted ChargeAmount |
297 |
Total Drug Medicare AllowedAmount |
228.14 |
Total Drug Medicare PaymentAmount |
222.82 |
Total Drug Medicare Standardized Payment Amount |
222.82 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
45 |
Number Of Medical Services |
152 |
Number Of Medicare Beneficiaries With Medical Services |
40 |
Total Medical Submitted Charge Amount |
6098 |
Total Medical Medicare Allowed Amount |
5389.64 |
Total Medical Medicare Payment Amount |
4130.32 |
Total Medical Medicare Standardized Payment Amount |
4096.87 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
24 |
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
25 |
Number Of Male Beneficiaries |
18 |
Number Of Non Hispanic White Beneficiaries |
|
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 |
43 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
0 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
|
Percent Of With Diabetes |
|
Percent Of With Hyperlipidemia |
|
Percent Of With Hypertension |
28 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
0 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
|
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
0.68 |