| National Provider Identifier [NPI]: | 1164546479 |
| Last Name Of The Provider | GORANTLA |
| First Name Of The Provider | KAVITA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9100 W 74TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHAWNEE MISSION |
| Zip Code Of The Provider | 662044004 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 137 |
| Number Of Services | 4551 |
| Number Of Medicare Beneficiaries | 2253 |
| Total Submitted Charge Amount | 551853.5 |
| Total Medicare Allowed Amount | 166243.75 |
| Total Medicare Payment Amount | 130908.73 |
| Total Medicare Standardized Payment Amount | 140413.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1445 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 4149.8 |
| Total Drug Medicare AllowedAmount | 931 |
| Total Drug Medicare PaymentAmount | 729.89 |
| Total Drug Medicare Standardized Payment Amount | 729.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 132 |
| Number Of Medical Services | 3106 |
| Number Of Medicare Beneficiaries With Medical Services | 2253 |
| Total Medical Submitted Charge Amount | 547703.7 |
| Total Medical Medicare Allowed Amount | 165312.75 |
| Total Medical Medicare Payment Amount | 130178.84 |
| Total Medical Medicare Standardized Payment Amount | 139683.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 317 |
| Number Of Beneficiaries Age 65 to 74 | 980 |
| Number Of Beneficiaries Age 75 to 84 | 596 |
| Number Of Beneficiaries Age Greater 84 | 360 |
| Number Of Female Beneficiaries | 1476 |
| Number Of Male Beneficiaries | 777 |
| Number Of Non Hispanic White Beneficiaries | 2040 |
| Number Of Black or African American Beneficiaries | 105 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1977 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 276 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3295 |