| National Provider Identifier [NPI]: | 1558369645 |
| Last Name Of The Provider | PUPA |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1730A 14TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MERIDIAN |
| Zip Code Of The Provider | 393014140 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 7060 |
| Number Of Medicare Beneficiaries | 5186 |
| Total Submitted Charge Amount | 583731 |
| Total Medicare Allowed Amount | 171920.14 |
| Total Medicare Payment Amount | 150240.17 |
| Total Medicare Standardized Payment Amount | 159996.63 |
| 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 | 66 |
| Number Of Medical Services | 7060 |
| Number Of Medicare Beneficiaries With Medical Services | 5186 |
| Total Medical Submitted Charge Amount | 583731 |
| Total Medical Medicare Allowed Amount | 171920.14 |
| Total Medical Medicare Payment Amount | 150240.17 |
| Total Medical Medicare Standardized Payment Amount | 159996.63 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1042 |
| Number Of Beneficiaries Age 65 to 74 | 2485 |
| Number Of Beneficiaries Age 75 to 84 | 1289 |
| Number Of Beneficiaries Age Greater 84 | 370 |
| Number Of Female Beneficiaries | 4432 |
| Number Of Male Beneficiaries | 754 |
| Number Of Non Hispanic White Beneficiaries | 3527 |
| Number Of Black or African American Beneficiaries | 1623 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3751 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1435 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9279 |