| National Provider Identifier [NPI]: | 1689803124 |
| Last Name Of The Provider | MUTHAPPA |
| First Name Of The Provider | DIVYA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 317 N BROAD ST |
| Street Address 2 Of The Provider | APT 410 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191071014 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 2107 |
| Number Of Medicare Beneficiaries | 734 |
| Total Submitted Charge Amount | 270778.53 |
| Total Medicare Allowed Amount | 131814.59 |
| Total Medicare Payment Amount | 97869.32 |
| Total Medicare Standardized Payment Amount | 102408.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 320 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 6516.03 |
| Total Drug Medicare AllowedAmount | 2142.78 |
| Total Drug Medicare PaymentAmount | 2027.83 |
| Total Drug Medicare Standardized Payment Amount | 2027.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 1787 |
| Number Of Medicare Beneficiaries With Medical Services | 734 |
| Total Medical Submitted Charge Amount | 264262.5 |
| Total Medical Medicare Allowed Amount | 129671.81 |
| Total Medical Medicare Payment Amount | 95841.49 |
| Total Medical Medicare Standardized Payment Amount | 100380.68 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 280 |
| Number Of Beneficiaries Age 75 to 84 | 193 |
| Number Of Beneficiaries Age Greater 84 | 160 |
| Number Of Female Beneficiaries | 459 |
| Number Of Male Beneficiaries | 275 |
| Number Of Non Hispanic White Beneficiaries | 596 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 115 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 528 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 206 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6125 |