National Provider Identifier [NPI]: |
1104818095 |
Last Name Of The Provider |
LAL |
First Name Of The Provider |
SUNDEEP |
Middle Initial Of The Provider |
S |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2705 HOSPITAL DR |
Street Address 2 Of The Provider |
STE 206 |
City Of The Provider |
VICTORIA |
Zip Code Of The Provider |
779015775 |
State Code Of The Provider |
TX |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pain Management |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
32 |
Number Of Services |
2560 |
Number Of Medicare Beneficiaries |
155 |
Total Submitted Charge Amount |
237818.45 |
Total Medicare Allowed Amount |
130529.54 |
Total Medicare Payment Amount |
102375.05 |
Total Medicare Standardized Payment Amount |
86908.19 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
1624 |
Number Of Medicare Beneficiaries With Drug Services |
88 |
Total Drug Submitted ChargeAmount |
13491 |
Total Drug Medicare AllowedAmount |
354.89 |
Total Drug Medicare PaymentAmount |
278.86 |
Total Drug Medicare Standardized Payment Amount |
278.86 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
29 |
Number Of Medical Services |
936 |
Number Of Medicare Beneficiaries With Medical Services |
155 |
Total Medical Submitted Charge Amount |
224327.45 |
Total Medical Medicare Allowed Amount |
130174.65 |
Total Medical Medicare Payment Amount |
102096.19 |
Total Medical Medicare Standardized Payment Amount |
86629.33 |
Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
38 |
Number Of Beneficiaries Age 65 to 74 |
50 |
Number Of Beneficiaries Age 75 to 84 |
50 |
Number Of Beneficiaries Age Greater 84 |
17 |
Number Of Female Beneficiaries |
86 |
Number Of Male Beneficiaries |
69 |
Number Of Non Hispanic White Beneficiaries |
113 |
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 |
115 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
40 |
Percent Of With Atrial Fibrillation |
12 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
14 |
Percent Of With Cancer |
12 |
Percent Of With Heart Failure |
32 |
Percent Of With Chronic Kidney Disease |
28 |
Percent Of With Chronic Obstructive Pulmonary Disease |
22 |
Percent Of With Depression |
41 |
Percent Of With Diabetes |
43 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
52 |
Percent Of With Osteoporosis |
17 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.4999 |