| National Provider Identifier [NPI]: | 1760532741 |
| Last Name Of The Provider | PURANIK |
| First Name Of The Provider | CHETAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 504 LEGACY PLZ W |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA PORTE |
| Zip Code Of The Provider | 463505254 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 5422 |
| Number Of Medicare Beneficiaries | 431 |
| Total Submitted Charge Amount | 4434776.82 |
| Total Medicare Allowed Amount | 509600.83 |
| Total Medicare Payment Amount | 385154.02 |
| Total Medicare Standardized Payment Amount | 388292.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 42 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 3360 |
| Total Drug Medicare AllowedAmount | 220.92 |
| Total Drug Medicare PaymentAmount | 161.07 |
| Total Drug Medicare Standardized Payment Amount | 161.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 5380 |
| Number Of Medicare Beneficiaries With Medical Services | 431 |
| Total Medical Submitted Charge Amount | 4431416.82 |
| Total Medical Medicare Allowed Amount | 509379.91 |
| Total Medical Medicare Payment Amount | 384992.95 |
| Total Medical Medicare Standardized Payment Amount | 388131.62 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 266 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 236 |
| Number Of Male Beneficiaries | 195 |
| Number Of Non Hispanic White Beneficiaries | 371 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 204 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 227 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3355 |