| National Provider Identifier [NPI]: | 1699952275 |
| Last Name Of The Provider | MOHANTY |
| First Name Of The Provider | GURU |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 60 HIGH ST |
| Street Address 2 Of The Provider | CMHVI |
| City Of The Provider | LEWISTON |
| Zip Code Of The Provider | 042407616 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 67 |
| Number Of Services | 1888 |
| Number Of Medicare Beneficiaries | 1067 |
| Total Submitted Charge Amount | 355160.9 |
| Total Medicare Allowed Amount | 120717.39 |
| Total Medicare Payment Amount | 93938.76 |
| Total Medicare Standardized Payment Amount | 99798.22 |
| 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 | 67 |
| Number Of Medical Services | 1888 |
| Number Of Medicare Beneficiaries With Medical Services | 1067 |
| Total Medical Submitted Charge Amount | 355160.9 |
| Total Medical Medicare Allowed Amount | 120717.39 |
| Total Medical Medicare Payment Amount | 93938.76 |
| Total Medical Medicare Standardized Payment Amount | 99798.22 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 266 |
| Number Of Beneficiaries Age 65 to 74 | 301 |
| Number Of Beneficiaries Age 75 to 84 | 322 |
| Number Of Beneficiaries Age Greater 84 | 178 |
| Number Of Female Beneficiaries | 595 |
| Number Of Male Beneficiaries | 472 |
| Number Of Non Hispanic White Beneficiaries | 1040 |
| Number Of Black or African American Beneficiaries | |
| 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 | 521 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 546 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6752 |