| National Provider Identifier [NPI]: | 1396047700 |
| Last Name Of The Provider | KODALI |
| First Name Of The Provider | SOBHAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1469 8TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BETHLEHEM |
| Zip Code Of The Provider | 180182256 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 3858 |
| Number Of Medicare Beneficiaries | 1693 |
| Total Submitted Charge Amount | 405812 |
| Total Medicare Allowed Amount | 202392.05 |
| Total Medicare Payment Amount | 151504.82 |
| Total Medicare Standardized Payment Amount | 156215.34 |
| 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 | 37 |
| Number Of Medical Services | 3858 |
| Number Of Medicare Beneficiaries With Medical Services | 1693 |
| Total Medical Submitted Charge Amount | 405812 |
| Total Medical Medicare Allowed Amount | 202392.05 |
| Total Medical Medicare Payment Amount | 151504.82 |
| Total Medical Medicare Standardized Payment Amount | 156215.34 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 284 |
| Number Of Beneficiaries Age 65 to 74 | 503 |
| Number Of Beneficiaries Age 75 to 84 | 520 |
| Number Of Beneficiaries Age Greater 84 | 386 |
| Number Of Female Beneficiaries | 895 |
| Number Of Male Beneficiaries | 798 |
| Number Of Non Hispanic White Beneficiaries | 1560 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 85 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1286 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 407 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.9351 |