| National Provider Identifier [NPI]: | 1184679953 |
| Last Name Of The Provider | JAGANNATHAN |
| First Name Of The Provider | SUBBIA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 695 N KELLOGG ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GALESBURG |
| Zip Code Of The Provider | 614012807 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 148 |
| Number Of Services | 3727 |
| Number Of Medicare Beneficiaries | 1921 |
| Total Submitted Charge Amount | 481389 |
| Total Medicare Allowed Amount | 89033.03 |
| Total Medicare Payment Amount | 70943.76 |
| Total Medicare Standardized Payment Amount | 72365.39 |
| 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 | 148 |
| Number Of Medical Services | 3727 |
| Number Of Medicare Beneficiaries With Medical Services | 1921 |
| Total Medical Submitted Charge Amount | 481389 |
| Total Medical Medicare Allowed Amount | 89033.03 |
| Total Medical Medicare Payment Amount | 70943.76 |
| Total Medical Medicare Standardized Payment Amount | 72365.39 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 307 |
| Number Of Beneficiaries Age 65 to 74 | 732 |
| Number Of Beneficiaries Age 75 to 84 | 581 |
| Number Of Beneficiaries Age Greater 84 | 301 |
| Number Of Female Beneficiaries | 1321 |
| Number Of Male Beneficiaries | 600 |
| Number Of Non Hispanic White Beneficiaries | 1810 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1397 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 524 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3818 |