| National Provider Identifier [NPI]: | 1245454693 |
| Last Name Of The Provider | MOULIK |
| First Name Of The Provider | SUPRATIK |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1706 PEBBLESTONE CT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSOURI CITY |
| Zip Code Of The Provider | 774591617 |
| 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 | 138 |
| Number Of Services | 5018 |
| Number Of Medicare Beneficiaries | 3131 |
| Total Submitted Charge Amount | 823571 |
| Total Medicare Allowed Amount | 134304.06 |
| Total Medicare Payment Amount | 103112.18 |
| Total Medicare Standardized Payment Amount | 105586.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 5018 |
| Number Of Medicare Beneficiaries With Medical Services | 3131 |
| Total Medical Submitted Charge Amount | 823571 |
| Total Medical Medicare Allowed Amount | 134304.06 |
| Total Medical Medicare Payment Amount | 103112.18 |
| Total Medical Medicare Standardized Payment Amount | 105586.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 606 |
| Number Of Beneficiaries Age 65 to 74 | 967 |
| Number Of Beneficiaries Age 75 to 84 | 914 |
| Number Of Beneficiaries Age Greater 84 | 644 |
| Number Of Female Beneficiaries | 1821 |
| Number Of Male Beneficiaries | 1310 |
| Number Of Non Hispanic White Beneficiaries | 2144 |
| Number Of Black or African American Beneficiaries | 326 |
| Number Of AsianPacific Islander Beneficiaries | 74 |
| Number Of Hispanic Beneficiaries | 533 |
| Number Of American Indian Alaska Native Beneficiaries | 28 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2005 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1126 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0287 |