National Provider Identifier [NPI]: |
1912974940 |
Last Name Of The Provider |
PULLURU |
First Name Of The Provider |
SOUJANYA |
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 |
2940 ROLLINGRIDGE RD |
Street Address 2 Of The Provider |
STE 300 |
City Of The Provider |
NAPERVILLE |
Zip Code Of The Provider |
605644216 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
36 |
Number Of Services |
364 |
Number Of Medicare Beneficiaries |
129 |
Total Submitted Charge Amount |
37676 |
Total Medicare Allowed Amount |
17769.58 |
Total Medicare Payment Amount |
11862.14 |
Total Medicare Standardized Payment Amount |
11890.65 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
41 |
Number Of Medicare Beneficiaries With Drug Services |
18 |
Total Drug Submitted ChargeAmount |
1201 |
Total Drug Medicare AllowedAmount |
683.2 |
Total Drug Medicare PaymentAmount |
650.78 |
Total Drug Medicare Standardized Payment Amount |
650.78 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
323 |
Number Of Medicare Beneficiaries With Medical Services |
129 |
Total Medical Submitted Charge Amount |
36475 |
Total Medical Medicare Allowed Amount |
17086.38 |
Total Medical Medicare Payment Amount |
11211.36 |
Total Medical Medicare Standardized Payment Amount |
11239.87 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
68 |
Number Of Beneficiaries Age 75 to 84 |
32 |
Number Of Beneficiaries Age Greater 84 |
12 |
Number Of Female Beneficiaries |
92 |
Number Of Male Beneficiaries |
37 |
Number Of Non Hispanic White Beneficiaries |
100 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
15 |
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 |
118 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
11 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
|
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
|
Percent Of With Chronic Kidney Disease |
12 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
51 |
Percent Of With Ischemic Heart Disease |
20 |
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
30 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
0.7806 |