| National Provider Identifier [NPI]: | 1306071824 |
| Last Name Of The Provider | DWIVEDI |
| First Name Of The Provider | SAMVID |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2799 W. GRAND AVENUE |
| Street Address 2 Of The Provider | HENRY FORD HOSPITAL |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 481012608 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 380 |
| Number Of Medicare Beneficiaries | 195 |
| Total Submitted Charge Amount | 116308 |
| Total Medicare Allowed Amount | 30464.22 |
| Total Medicare Payment Amount | 23798.79 |
| Total Medicare Standardized Payment Amount | 21944.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 380 |
| Number Of Medicare Beneficiaries With Medical Services | 195 |
| Total Medical Submitted Charge Amount | 116308 |
| Total Medical Medicare Allowed Amount | 30464.22 |
| Total Medical Medicare Payment Amount | 23798.79 |
| Total Medical Medicare Standardized Payment Amount | 21944.19 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 75 |
| Number Of Beneficiaries Age 65 to 74 | 71 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 117 |
| Number Of Male Beneficiaries | 78 |
| Number Of Non Hispanic White Beneficiaries | 101 |
| Number Of Black or African American Beneficiaries | 83 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8426 |