| National Provider Identifier [NPI]: | 1699749077 |
| Last Name Of The Provider | MUDALIAR |
| First Name Of The Provider | CHANDRAMOHAN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 122O FIFTH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 76104 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 4233 |
| Number Of Medicare Beneficiaries | 342 |
| Total Submitted Charge Amount | 289529 |
| Total Medicare Allowed Amount | 225459.08 |
| Total Medicare Payment Amount | 169098.23 |
| Total Medicare Standardized Payment Amount | 163505.17 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 864 |
| Number Of Medicare Beneficiaries With Drug Services | 149 |
| Total Drug Submitted ChargeAmount | 17909 |
| Total Drug Medicare AllowedAmount | 6618.01 |
| Total Drug Medicare PaymentAmount | 5794.67 |
| Total Drug Medicare Standardized Payment Amount | 5794.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 3369 |
| Number Of Medicare Beneficiaries With Medical Services | 342 |
| Total Medical Submitted Charge Amount | 271620 |
| Total Medical Medicare Allowed Amount | 218841.07 |
| Total Medical Medicare Payment Amount | 163303.56 |
| Total Medical Medicare Standardized Payment Amount | 157710.5 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 62 |
| Number Of Beneficiaries Age 65 to 74 | 131 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 180 |
| Number Of Male Beneficiaries | 162 |
| Number Of Non Hispanic White Beneficiaries | 169 |
| Number Of Black or African American Beneficiaries | 138 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 269 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 73 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0569 |