| National Provider Identifier [NPI]: | 1023158482 |
| Last Name Of The Provider | GAUTAM |
| First Name Of The Provider | ARCHANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3500 HEALTHPLEX PKWY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | NORMAN |
| Zip Code Of The Provider | 730729738 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 4778 |
| Number Of Medicare Beneficiaries | 1131 |
| Total Submitted Charge Amount | 868279.72 |
| Total Medicare Allowed Amount | 368331.44 |
| Total Medicare Payment Amount | 278074.24 |
| Total Medicare Standardized Payment Amount | 285031.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 183 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 16260 |
| Total Drug Medicare AllowedAmount | 9561.98 |
| Total Drug Medicare PaymentAmount | 7354.43 |
| Total Drug Medicare Standardized Payment Amount | 7354.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 93 |
| Number Of Medical Services | 4595 |
| Number Of Medicare Beneficiaries With Medical Services | 1131 |
| Total Medical Submitted Charge Amount | 852019.72 |
| Total Medical Medicare Allowed Amount | 358769.46 |
| Total Medical Medicare Payment Amount | 270719.81 |
| Total Medical Medicare Standardized Payment Amount | 277676.83 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 177 |
| Number Of Beneficiaries Age 65 to 74 | 431 |
| Number Of Beneficiaries Age 75 to 84 | 352 |
| Number Of Beneficiaries Age Greater 84 | 171 |
| Number Of Female Beneficiaries | 696 |
| Number Of Male Beneficiaries | 435 |
| Number Of Non Hispanic White Beneficiaries | 1017 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 46 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 884 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 247 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.728 |