National Provider Identifier [NPI]: |
1184887887 |
Last Name Of The Provider |
SUMMANWAR |
First Name Of The Provider |
DIANA |
Middle Initial Of The Provider |
P |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
550 UNIVERSITY BLVD |
Street Address 2 Of The Provider |
UH 3005 |
City Of The Provider |
INDIANAPOLIS |
Zip Code Of The Provider |
462025149 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
33 |
Number Of Services |
601 |
Number Of Medicare Beneficiaries |
309 |
Total Submitted Charge Amount |
99195 |
Total Medicare Allowed Amount |
40708.02 |
Total Medicare Payment Amount |
29323.75 |
Total Medicare Standardized Payment Amount |
31132.93 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
6 |
Number Of Drug Services |
26 |
Number Of Medicare Beneficiaries With Drug Services |
24 |
Total Drug Submitted ChargeAmount |
1369 |
Total Drug Medicare AllowedAmount |
886.31 |
Total Drug Medicare PaymentAmount |
866.32 |
Total Drug Medicare Standardized Payment Amount |
866.32 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
27 |
Number Of Medical Services |
575 |
Number Of Medicare Beneficiaries With Medical Services |
309 |
Total Medical Submitted Charge Amount |
97826 |
Total Medical Medicare Allowed Amount |
39821.71 |
Total Medical Medicare Payment Amount |
28457.43 |
Total Medical Medicare Standardized Payment Amount |
30266.61 |
Average Age Of Beneficiaries |
60 |
Number Of Beneficiaries Age Less65 |
182 |
Number Of Beneficiaries Age 65 to 74 |
79 |
Number Of Beneficiaries Age 75 to 84 |
33 |
Number Of Beneficiaries Age Greater 84 |
15 |
Number Of Female Beneficiaries |
214 |
Number Of Male Beneficiaries |
95 |
Number Of Non Hispanic White Beneficiaries |
115 |
Number Of Black or African American Beneficiaries |
183 |
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
103 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
206 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
5 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
44 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
41 |
Percent Of With Hypertension |
67 |
Percent Of With Ischemic Heart Disease |
30 |
Percent Of With Osteoporosis |
5 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
35 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.7942 |