| National Provider Identifier [NPI]: | 1871579276 |
| Last Name Of The Provider | KUKKALLI |
| First Name Of The Provider | BHUSHAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6565 FANNIN ST. |
| Street Address 2 Of The Provider | METHODIST HOSPITAL |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 77030 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 42 |
| Number Of Services | 828 |
| Number Of Medicare Beneficiaries | 594 |
| Total Submitted Charge Amount | 1093691 |
| Total Medicare Allowed Amount | 112969.93 |
| Total Medicare Payment Amount | 87605.67 |
| Total Medicare Standardized Payment Amount | 87422.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 828 |
| Number Of Medicare Beneficiaries With Medical Services | 594 |
| Total Medical Submitted Charge Amount | 1093691 |
| Total Medical Medicare Allowed Amount | 112969.93 |
| Total Medical Medicare Payment Amount | 87605.67 |
| Total Medical Medicare Standardized Payment Amount | 87422.31 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 229 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 124 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 369 |
| Number Of Male Beneficiaries | 225 |
| Number Of Non Hispanic White Beneficiaries | 270 |
| Number Of Black or African American Beneficiaries | 211 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 93 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 266 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.507 |