| National Provider Identifier [NPI]: | 1417047663 |
| Last Name Of The Provider | DESAI |
| First Name Of The Provider | GAUTAM |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 S INDEPENDENCE BLVD |
| Street Address 2 Of The Provider | SUITE #3 |
| City Of The Provider | VIRGINIA BEACH |
| Zip Code Of The Provider | 23453 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 710 |
| Number Of Medicare Beneficiaries | 163 |
| Total Submitted Charge Amount | 51804 |
| Total Medicare Allowed Amount | 44417.25 |
| Total Medicare Payment Amount | 28741.79 |
| Total Medicare Standardized Payment Amount | 29372.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 2290 |
| Total Drug Medicare AllowedAmount | 1241.74 |
| Total Drug Medicare PaymentAmount | 1212.6 |
| Total Drug Medicare Standardized Payment Amount | 1212.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 648 |
| Number Of Medicare Beneficiaries With Medical Services | 163 |
| Total Medical Submitted Charge Amount | 49514 |
| Total Medical Medicare Allowed Amount | 43175.51 |
| Total Medical Medicare Payment Amount | 27529.19 |
| Total Medical Medicare Standardized Payment Amount | 28160.03 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 91 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 62 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 17 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 20 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8768 |