| National Provider Identifier [NPI]: | 1457375586 |
| Last Name Of The Provider | MUTHALALY |
| First Name Of The Provider | BOBBY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2000 S WHEELING AVE |
| Street Address 2 Of The Provider | STE. 510 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741045649 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 3717 |
| Number Of Medicare Beneficiaries | 1001 |
| Total Submitted Charge Amount | 947823.39 |
| Total Medicare Allowed Amount | 475962.69 |
| Total Medicare Payment Amount | 362757.99 |
| Total Medicare Standardized Payment Amount | 385502.69 |
| 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 | 18 |
| Number Of Medical Services | 3717 |
| Number Of Medicare Beneficiaries With Medical Services | 1001 |
| Total Medical Submitted Charge Amount | 947823.39 |
| Total Medical Medicare Allowed Amount | 475962.69 |
| Total Medical Medicare Payment Amount | 362757.99 |
| Total Medical Medicare Standardized Payment Amount | 385502.69 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 296 |
| Number Of Beneficiaries Age 65 to 74 | 334 |
| Number Of Beneficiaries Age 75 to 84 | 263 |
| Number Of Beneficiaries Age Greater 84 | 108 |
| Number Of Female Beneficiaries | 494 |
| Number Of Male Beneficiaries | 507 |
| Number Of Non Hispanic White Beneficiaries | 690 |
| Number Of Black or African American Beneficiaries | 157 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 115 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 649 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 352 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 4.3627 |