| National Provider Identifier [NPI]: | 1497747703 |
| Last Name Of The Provider | WALALIYADDA |
| First Name Of The Provider | ANANDA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1448 E CENTER ST |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832014132 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 205750 |
| Number Of Medicare Beneficiaries | 553 |
| Total Submitted Charge Amount | 6836377.48 |
| Total Medicare Allowed Amount | 3808854.56 |
| Total Medicare Payment Amount | 2960500.47 |
| Total Medicare Standardized Payment Amount | 2963621.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 17 |
| Number Of Drug Services | 199041 |
| Number Of Medicare Beneficiaries With Drug Services | 346 |
| Total Drug Submitted ChargeAmount | 5945876.08 |
| Total Drug Medicare AllowedAmount | 3481332.17 |
| Total Drug Medicare PaymentAmount | 2706060.65 |
| Total Drug Medicare Standardized Payment Amount | 2706060.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 6709 |
| Number Of Medicare Beneficiaries With Medical Services | 553 |
| Total Medical Submitted Charge Amount | 890501.4 |
| Total Medical Medicare Allowed Amount | 327522.39 |
| Total Medical Medicare Payment Amount | 254439.82 |
| Total Medical Medicare Standardized Payment Amount | 257560.91 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 129 |
| Number Of Beneficiaries Age 65 to 74 | 255 |
| Number Of Beneficiaries Age 75 to 84 | 139 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 403 |
| Number Of Male Beneficiaries | 150 |
| Number Of Non Hispanic White Beneficiaries | 513 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 428 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 27 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.1514 |