| National Provider Identifier [NPI]: | 1225182637 |
| Last Name Of The Provider | GULLA |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6019 WALNUT GROVE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEMPHIS |
| Zip Code Of The Provider | 381202113 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 148 |
| Number Of Services | 6736 |
| Number Of Medicare Beneficiaries | 4489 |
| Total Submitted Charge Amount | 728579 |
| Total Medicare Allowed Amount | 183416.57 |
| Total Medicare Payment Amount | 137809.1 |
| Total Medicare Standardized Payment Amount | 147653.41 |
| 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 | 148 |
| Number Of Medical Services | 6736 |
| Number Of Medicare Beneficiaries With Medical Services | 4489 |
| Total Medical Submitted Charge Amount | 728579 |
| Total Medical Medicare Allowed Amount | 183416.57 |
| Total Medical Medicare Payment Amount | 137809.1 |
| Total Medical Medicare Standardized Payment Amount | 147653.41 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 821 |
| Number Of Beneficiaries Age 65 to 74 | 1636 |
| Number Of Beneficiaries Age 75 to 84 | 1389 |
| Number Of Beneficiaries Age Greater 84 | 643 |
| Number Of Female Beneficiaries | 2878 |
| Number Of Male Beneficiaries | 1611 |
| Number Of Non Hispanic White Beneficiaries | 3430 |
| Number Of Black or African American Beneficiaries | 973 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3324 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1165 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9453 |