| National Provider Identifier [NPI]: | 1598721326 |
| Last Name Of The Provider | GOLLA |
| First Name Of The Provider | BHASKAR |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 MEMORIAL CIR |
| Street Address 2 Of The Provider | SUITE B |
| City Of The Provider | ORMOND BEACH |
| Zip Code Of The Provider | 321745054 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 5733 |
| Number Of Medicare Beneficiaries | 3109 |
| Total Submitted Charge Amount | 698608 |
| Total Medicare Allowed Amount | 183894.12 |
| Total Medicare Payment Amount | 141448.17 |
| Total Medicare Standardized Payment Amount | 141585.78 |
| 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 | 163 |
| Number Of Medical Services | 5733 |
| Number Of Medicare Beneficiaries With Medical Services | 3109 |
| Total Medical Submitted Charge Amount | 698608 |
| Total Medical Medicare Allowed Amount | 183894.12 |
| Total Medical Medicare Payment Amount | 141448.17 |
| Total Medical Medicare Standardized Payment Amount | 141585.78 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 567 |
| Number Of Beneficiaries Age 65 to 74 | 966 |
| Number Of Beneficiaries Age 75 to 84 | 887 |
| Number Of Beneficiaries Age Greater 84 | 689 |
| Number Of Female Beneficiaries | 1826 |
| Number Of Male Beneficiaries | 1283 |
| Number Of Non Hispanic White Beneficiaries | 2518 |
| Number Of Black or African American Beneficiaries | 228 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 317 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2147 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 962 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8574 |