| National Provider Identifier [NPI]: | 1205922770 |
| Last Name Of The Provider | MUTHUSWAMY |
| First Name Of The Provider | PETHAM |
| 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 | 7531 SOUTH STONY ISLAND |
| Street Address 2 Of The Provider | SUITE 169 |
| City Of The Provider | CHICAGO |
| Zip Code Of The Provider | 60649 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 2499 |
| Number Of Medicare Beneficiaries | 439 |
| Total Submitted Charge Amount | 771590 |
| Total Medicare Allowed Amount | 401644.86 |
| Total Medicare Payment Amount | 310564.45 |
| Total Medicare Standardized Payment Amount | 289196.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 640 |
| Total Drug Medicare AllowedAmount | 192.64 |
| Total Drug Medicare PaymentAmount | 188.8 |
| Total Drug Medicare Standardized Payment Amount | 188.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 2483 |
| Number Of Medicare Beneficiaries With Medical Services | 439 |
| Total Medical Submitted Charge Amount | 770950 |
| Total Medical Medicare Allowed Amount | 401452.22 |
| Total Medical Medicare Payment Amount | 310375.65 |
| Total Medical Medicare Standardized Payment Amount | 289007.28 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 87 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 194 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | 405 |
| 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 | 95 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 344 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 37 |
| Percent Of With Asthma | 43 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 66 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 23 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.8017 |