| National Provider Identifier [NPI]: | 1295765279 |
| Last Name Of The Provider | KOTAK |
| First Name Of The Provider | KANCHAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 27 E MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIDDLETOWN |
| Zip Code Of The Provider | 197091445 |
| State Code Of The Provider | DE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 984 |
| Number Of Medicare Beneficiaries | 123 |
| Total Submitted Charge Amount | 175138.94 |
| Total Medicare Allowed Amount | 74916.24 |
| Total Medicare Payment Amount | 55974.95 |
| Total Medicare Standardized Payment Amount | 58376.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 2153.58 |
| Total Drug Medicare AllowedAmount | 1729.42 |
| Total Drug Medicare PaymentAmount | 1694.76 |
| Total Drug Medicare Standardized Payment Amount | 1694.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 907 |
| Number Of Medicare Beneficiaries With Medical Services | 119 |
| Total Medical Submitted Charge Amount | 172985.36 |
| Total Medical Medicare Allowed Amount | 73186.82 |
| Total Medical Medicare Payment Amount | 54280.19 |
| Total Medical Medicare Standardized Payment Amount | 56681.34 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 53 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 37 |
| Number Of Non Hispanic White Beneficiaries | 75 |
| Number Of Black or African American Beneficiaries | |
| 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 | 63 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3859 |