| National Provider Identifier [NPI]: | 1528279965 |
| Last Name Of The Provider | KOTICHA |
| First Name Of The Provider | KIRTAN |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 301 BERT KOUNS LOOP |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHREVEPORT |
| Zip Code Of The Provider | 711068124 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 52706 |
| Number Of Medicare Beneficiaries | 226 |
| Total Submitted Charge Amount | 2117759.18 |
| Total Medicare Allowed Amount | 914811.89 |
| Total Medicare Payment Amount | 717354.56 |
| Total Medicare Standardized Payment Amount | 720861.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 68 |
| Number Of Drug Services | 51319 |
| Number Of Medicare Beneficiaries With Drug Services | 136 |
| Total Drug Submitted ChargeAmount | 1909132.18 |
| Total Drug Medicare AllowedAmount | 841631.91 |
| Total Drug Medicare PaymentAmount | 659833.1 |
| Total Drug Medicare Standardized Payment Amount | 659833.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 1387 |
| Number Of Medicare Beneficiaries With Medical Services | 214 |
| Total Medical Submitted Charge Amount | 208627 |
| Total Medical Medicare Allowed Amount | 73179.98 |
| Total Medical Medicare Payment Amount | 57521.46 |
| Total Medical Medicare Standardized Payment Amount | 61028.01 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 115 |
| Number Of Non Hispanic White Beneficiaries | 147 |
| 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 | 159 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 67 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 41 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 2.0042 |