| National Provider Identifier [NPI]: | 1346206364 |
| Last Name Of The Provider | SULTANA |
| First Name Of The Provider | AYESHA |
| 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 | 3495 BAILEY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BUFFALO |
| Zip Code Of The Provider | 142151129 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 283 |
| Number Of Medicare Beneficiaries | 120 |
| Total Submitted Charge Amount | 26415.15 |
| Total Medicare Allowed Amount | 19586.09 |
| Total Medicare Payment Amount | 13368.21 |
| Total Medicare Standardized Payment Amount | 14018.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 13 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 380 |
| Total Drug Medicare AllowedAmount | 210.48 |
| Total Drug Medicare PaymentAmount | 206.24 |
| Total Drug Medicare Standardized Payment Amount | 206.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 270 |
| Number Of Medicare Beneficiaries With Medical Services | 120 |
| Total Medical Submitted Charge Amount | 26035.15 |
| Total Medical Medicare Allowed Amount | 19375.61 |
| Total Medical Medicare Payment Amount | 13161.97 |
| Total Medical Medicare Standardized Payment Amount | 13812.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 48 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 48 |
| Number Of Non Hispanic White Beneficiaries | 71 |
| Number Of Black or African American Beneficiaries | 33 |
| 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 | 104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 16 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9921 |