National Provider Identifier [NPI]: |
1780654400 |
Last Name Of The Provider |
SUDHAKAR |
First Name Of The Provider |
SHEILA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1717 W CHANDLER BLVD |
Street Address 2 Of The Provider |
|
City Of The Provider |
CHANDLER |
Zip Code Of The Provider |
852246145 |
State Code Of The Provider |
AZ |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
93 |
Number Of Medicare Beneficiaries |
28 |
Total Submitted Charge Amount |
11765.13 |
Total Medicare Allowed Amount |
6836.78 |
Total Medicare Payment Amount |
5387.69 |
Total Medicare Standardized Payment Amount |
5633.66 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
17 |
Number Of Medicare Beneficiaries With Drug Services |
15 |
Total Drug Submitted ChargeAmount |
796.13 |
Total Drug Medicare AllowedAmount |
617.7 |
Total Drug Medicare PaymentAmount |
604.45 |
Total Drug Medicare Standardized Payment Amount |
604.45 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
11 |
Number Of Medical Services |
76 |
Number Of Medicare Beneficiaries With Medical Services |
28 |
Total Medical Submitted Charge Amount |
10969 |
Total Medical Medicare Allowed Amount |
6219.08 |
Total Medical Medicare Payment Amount |
4783.24 |
Total Medical Medicare Standardized Payment Amount |
5029.21 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
16 |
Number Of Male Beneficiaries |
12 |
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 |
|
Number Of Beneficiaries With Medicare Medicaid Entitlement |
|
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
0 |
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 |
50 |
Percent Of With Hyperlipidemia |
54 |
Percent Of With Hypertension |
61 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
|
Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
0.9934 |