| National Provider Identifier [NPI]: | 1831153469 |
| Last Name Of The Provider | MITRA |
| First Name Of The Provider | SUDESHNA |
| 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 | 397 N WICKHAM RD |
| Street Address 2 Of The Provider | 101 |
| City Of The Provider | MELBOURNE |
| Zip Code Of The Provider | 329358669 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 4503 |
| Number Of Medicare Beneficiaries | 734 |
| Total Submitted Charge Amount | 602500.05 |
| Total Medicare Allowed Amount | 385559.22 |
| Total Medicare Payment Amount | 284502.32 |
| Total Medicare Standardized Payment Amount | 285908.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 193 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 4585 |
| Total Drug Medicare AllowedAmount | 296.58 |
| Total Drug Medicare PaymentAmount | 200.48 |
| Total Drug Medicare Standardized Payment Amount | 200.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 4310 |
| Number Of Medicare Beneficiaries With Medical Services | 734 |
| Total Medical Submitted Charge Amount | 597915.05 |
| Total Medical Medicare Allowed Amount | 385262.64 |
| Total Medical Medicare Payment Amount | 284301.84 |
| Total Medical Medicare Standardized Payment Amount | 285707.88 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 159 |
| Number Of Beneficiaries Age 65 to 74 | 287 |
| Number Of Beneficiaries Age 75 to 84 | 207 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 478 |
| Number Of Male Beneficiaries | 256 |
| Number Of Non Hispanic White Beneficiaries | 639 |
| Number Of Black or African American Beneficiaries | 48 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 616 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 118 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6699 |