| National Provider Identifier [NPI]: | 1144387838 |
| Last Name Of The Provider | D'MELLO |
| First Name Of The Provider | SURESH |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19 HALLS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | OLD LYME |
| Zip Code Of The Provider | 063711457 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 2220 |
| Number Of Medicare Beneficiaries | 400 |
| Total Submitted Charge Amount | 233446.38 |
| Total Medicare Allowed Amount | 133118.62 |
| Total Medicare Payment Amount | 102568.76 |
| Total Medicare Standardized Payment Amount | 96359.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 183 |
| Number Of Medicare Beneficiaries With Drug Services | 124 |
| Total Drug Submitted ChargeAmount | 5508.38 |
| Total Drug Medicare AllowedAmount | 3239.25 |
| Total Drug Medicare PaymentAmount | 3135.74 |
| Total Drug Medicare Standardized Payment Amount | 3135.74 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 2037 |
| Number Of Medicare Beneficiaries With Medical Services | 400 |
| Total Medical Submitted Charge Amount | 227938 |
| Total Medical Medicare Allowed Amount | 129879.37 |
| Total Medical Medicare Payment Amount | 99433.02 |
| Total Medical Medicare Standardized Payment Amount | 93224.17 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 58 |
| Number Of Beneficiaries Age 65 to 74 | 173 |
| Number Of Beneficiaries Age 75 to 84 | 102 |
| Number Of Beneficiaries Age Greater 84 | 67 |
| Number Of Female Beneficiaries | 217 |
| Number Of Male Beneficiaries | 183 |
| Number Of Non Hispanic White Beneficiaries | 361 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 305 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0962 |