| National Provider Identifier [NPI]: | 1033108089 |
| Last Name Of The Provider | GUPTA |
| First Name Of The Provider | MONALI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 HOLCOMBE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770304009 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 12677 |
| Number Of Medicare Beneficiaries | 3830 |
| Total Submitted Charge Amount | 1935092 |
| Total Medicare Allowed Amount | 607242.87 |
| Total Medicare Payment Amount | 537393.56 |
| Total Medicare Standardized Payment Amount | 543627.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 4060 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 8120 |
| Total Drug Medicare AllowedAmount | 1661.55 |
| Total Drug Medicare PaymentAmount | 1275.02 |
| Total Drug Medicare Standardized Payment Amount | 1275.02 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 8617 |
| Number Of Medicare Beneficiaries With Medical Services | 3830 |
| Total Medical Submitted Charge Amount | 1926972 |
| Total Medical Medicare Allowed Amount | 605581.32 |
| Total Medical Medicare Payment Amount | 536118.54 |
| Total Medical Medicare Standardized Payment Amount | 542352.61 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 2533 |
| Number Of Beneficiaries Age 75 to 84 | 973 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 3696 |
| Number Of Male Beneficiaries | 134 |
| Number Of Non Hispanic White Beneficiaries | 3590 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 57 |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3750 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 80 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 2 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 4 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 6 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 14 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7114 |