| National Provider Identifier [NPI]: | 1649462102 |
| Last Name Of The Provider | GUPTA |
| First Name Of The Provider | BHAWNA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.B.B.S. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2555 MARVIN RD NE |
| Street Address 2 Of The Provider | PMG SW WA HAWKS PRAIRIE IM |
| City Of The Provider | LACEY |
| Zip Code Of The Provider | 985163138 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 800 |
| Number Of Medicare Beneficiaries | 354 |
| Total Submitted Charge Amount | 147430 |
| Total Medicare Allowed Amount | 64285.45 |
| Total Medicare Payment Amount | 44628.78 |
| Total Medicare Standardized Payment Amount | 45470.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 68 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 2688 |
| Total Drug Medicare AllowedAmount | 1529.4 |
| Total Drug Medicare PaymentAmount | 1498.27 |
| Total Drug Medicare Standardized Payment Amount | 1498.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 732 |
| Number Of Medicare Beneficiaries With Medical Services | 354 |
| Total Medical Submitted Charge Amount | 144742 |
| Total Medical Medicare Allowed Amount | 62756.05 |
| Total Medical Medicare Payment Amount | 43130.51 |
| Total Medical Medicare Standardized Payment Amount | 43971.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 107 |
| Number Of Beneficiaries Age Greater 84 | 39 |
| Number Of Female Beneficiaries | 227 |
| Number Of Male Beneficiaries | 127 |
| Number Of Non Hispanic White Beneficiaries | 322 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 43 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1005 |