| National Provider Identifier [NPI]: | 1508978503 |
| Last Name Of The Provider | SURENDRAN-NAIR |
| First Name Of The Provider | KODAKKATU |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2051 W GRAND BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482081105 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Psychiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 201 |
| Number Of Medicare Beneficiaries | 90 |
| Total Submitted Charge Amount | 10716 |
| Total Medicare Allowed Amount | 8509.74 |
| Total Medicare Payment Amount | 4328.92 |
| Total Medicare Standardized Payment Amount | 4233.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 1394 |
| Total Drug Medicare AllowedAmount | 1322.94 |
| Total Drug Medicare PaymentAmount | 598.47 |
| Total Drug Medicare Standardized Payment Amount | 598.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 8 |
| Number Of Medical Services | 133 |
| Number Of Medicare Beneficiaries With Medical Services | 84 |
| Total Medical Submitted Charge Amount | 9322 |
| Total Medical Medicare Allowed Amount | 7186.8 |
| Total Medical Medicare Payment Amount | 3730.45 |
| Total Medical Medicare Standardized Payment Amount | 3635.39 |
| Average Age Of Beneficiaries | 50 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 49 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | 47 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 51 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 68 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2429 |