| National Provider Identifier [NPI]: | 1457380214 |
| Last Name Of The Provider | SANGAM |
| 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 | 3627 UNIVERSITY BLVD S |
| Street Address 2 Of The Provider | SUITE 415 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322164230 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1420 |
| Number Of Medicare Beneficiaries | 323 |
| Total Submitted Charge Amount | 261415 |
| Total Medicare Allowed Amount | 123969.66 |
| Total Medicare Payment Amount | 92315.5 |
| Total Medicare Standardized Payment Amount | 92351.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 3632 |
| Total Drug Medicare AllowedAmount | 1363.45 |
| Total Drug Medicare PaymentAmount | 1316.35 |
| Total Drug Medicare Standardized Payment Amount | 1316.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1366 |
| Number Of Medicare Beneficiaries With Medical Services | 320 |
| Total Medical Submitted Charge Amount | 257783 |
| Total Medical Medicare Allowed Amount | 122606.21 |
| Total Medical Medicare Payment Amount | 90999.15 |
| Total Medical Medicare Standardized Payment Amount | 91035.05 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 98 |
| Number Of Beneficiaries Age 75 to 84 | 92 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 111 |
| Number Of Non Hispanic White Beneficiaries | 251 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 255 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 1.9984 |