| National Provider Identifier [NPI]: | 1104836790 |
| Last Name Of The Provider | OVELLA |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 804 HEAVENS DR |
| Street Address 2 Of The Provider | STE 106 |
| City Of The Provider | MANDEVILLE |
| Zip Code Of The Provider | 70471 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 811 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 120718 |
| Total Medicare Allowed Amount | 54407.57 |
| Total Medicare Payment Amount | 38557.34 |
| Total Medicare Standardized Payment Amount | 41475.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 108 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 7795 |
| Total Drug Medicare AllowedAmount | 3112.4 |
| Total Drug Medicare PaymentAmount | 3030.81 |
| Total Drug Medicare Standardized Payment Amount | 3030.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 703 |
| Number Of Medicare Beneficiaries With Medical Services | 220 |
| Total Medical Submitted Charge Amount | 112923 |
| Total Medical Medicare Allowed Amount | 51295.17 |
| Total Medical Medicare Payment Amount | 35526.53 |
| Total Medical Medicare Standardized Payment Amount | 38444.95 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 87 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 60 |
| Number Of Non Hispanic White Beneficiaries | 207 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 197 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 24 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1598 |