| National Provider Identifier [NPI]: | 1386678290 |
| Last Name Of The Provider | SHETTY |
| First Name Of The Provider | MAHADEVAN |
| 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 | 385 MAIN ST S, |
| Street Address 2 Of The Provider | C/O NVRA UNION SQUARE BLDG#1 |
| City Of The Provider | SOUTHBURY |
| Zip Code Of The Provider | 064884240 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 141 |
| Number Of Services | 4708 |
| Number Of Medicare Beneficiaries | 1711 |
| Total Submitted Charge Amount | 872689 |
| Total Medicare Allowed Amount | 224820.68 |
| Total Medicare Payment Amount | 181668.19 |
| Total Medicare Standardized Payment Amount | 168335.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1784 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 8799 |
| Total Drug Medicare AllowedAmount | 2449.96 |
| Total Drug Medicare PaymentAmount | 1888.44 |
| Total Drug Medicare Standardized Payment Amount | 1888.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 2924 |
| Number Of Medicare Beneficiaries With Medical Services | 1711 |
| Total Medical Submitted Charge Amount | 863890 |
| Total Medical Medicare Allowed Amount | 222370.72 |
| Total Medical Medicare Payment Amount | 179779.75 |
| Total Medical Medicare Standardized Payment Amount | 166446.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 330 |
| Number Of Beneficiaries Age 65 to 74 | 554 |
| Number Of Beneficiaries Age 75 to 84 | 518 |
| Number Of Beneficiaries Age Greater 84 | 309 |
| Number Of Female Beneficiaries | 1143 |
| Number Of Male Beneficiaries | 568 |
| Number Of Non Hispanic White Beneficiaries | 1397 |
| Number Of Black or African American Beneficiaries | 112 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 153 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1027 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 684 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5648 |