| National Provider Identifier [NPI]: | 1205813532 |
| Last Name Of The Provider | KALISETTI |
| First Name Of The Provider | DAMAYANTHI |
| 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 | 4050 DUBLIN BLVD. |
| Street Address 2 Of The Provider | |
| City Of The Provider | DUBLIN |
| Zip Code Of The Provider | 945683112 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 723 |
| Number Of Medicare Beneficiaries | 205 |
| Total Submitted Charge Amount | 112653 |
| Total Medicare Allowed Amount | 48250.6 |
| Total Medicare Payment Amount | 36293.34 |
| Total Medicare Standardized Payment Amount | 32490.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 94 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 2075 |
| Total Drug Medicare AllowedAmount | 1608.23 |
| Total Drug Medicare PaymentAmount | 1547.05 |
| Total Drug Medicare Standardized Payment Amount | 1547.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 629 |
| Number Of Medicare Beneficiaries With Medical Services | 205 |
| Total Medical Submitted Charge Amount | 110578 |
| Total Medical Medicare Allowed Amount | 46642.37 |
| Total Medical Medicare Payment Amount | 34746.29 |
| Total Medical Medicare Standardized Payment Amount | 30943.47 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 16 |
| Number Of Beneficiaries Age 65 to 74 | 80 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 142 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 137 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 156 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 49 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3045 |