National Provider Identifier [NPI]: |
1720217896 |
Last Name Of The Provider |
PALLA |
First Name Of The Provider |
SWAPNA |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2801 W BANCROFT ST |
Street Address 2 Of The Provider |
|
City Of The Provider |
TOLEDO |
Zip Code Of The Provider |
436063328 |
State Code Of The Provider |
OH |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
31 |
Number Of Services |
342 |
Number Of Medicare Beneficiaries |
63 |
Total Submitted Charge Amount |
39530 |
Total Medicare Allowed Amount |
19768.69 |
Total Medicare Payment Amount |
13949.36 |
Total Medicare Standardized Payment Amount |
14689.3 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
31 |
Number Of Medicare Beneficiaries With Drug Services |
20 |
Total Drug Submitted ChargeAmount |
642 |
Total Drug Medicare AllowedAmount |
266.59 |
Total Drug Medicare PaymentAmount |
258.32 |
Total Drug Medicare Standardized Payment Amount |
258.32 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
24 |
Number Of Medical Services |
311 |
Number Of Medicare Beneficiaries With Medical Services |
63 |
Total Medical Submitted Charge Amount |
38888 |
Total Medical Medicare Allowed Amount |
19502.1 |
Total Medical Medicare Payment Amount |
13691.04 |
Total Medical Medicare Standardized Payment Amount |
14430.98 |
Average Age Of Beneficiaries |
53 |
Number Of Beneficiaries Age Less65 |
39 |
Number Of Beneficiaries Age 65 to 74 |
|
Number Of Beneficiaries Age 75 to 84 |
|
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
36 |
Number Of Male Beneficiaries |
27 |
Number Of Non Hispanic White Beneficiaries |
29 |
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 |
23 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
40 |
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 |
|
Percent Of With Chronic Obstructive Pulmonary Disease |
|
Percent Of With Depression |
40 |
Percent Of With Diabetes |
29 |
Percent Of With Hyperlipidemia |
37 |
Percent Of With Hypertension |
54 |
Percent Of With Ischemic Heart Disease |
|
Percent Of With Osteoporosis |
|
Percent Of With Rheumatoid Arthritis Osteoarthritis |
27 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.1552 |