| National Provider Identifier [NPI]: | 1396833604 |
| Last Name Of The Provider | DAVE |
| First Name Of The Provider | MITUL |
| 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 | 9055 CHEVROLET DRIVE |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | ELLICOTT CITY |
| Zip Code Of The Provider | 21042 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 31 |
| Number Of Services | 3967 |
| Number Of Medicare Beneficiaries | 785 |
| Total Submitted Charge Amount | 509904 |
| Total Medicare Allowed Amount | 346287.87 |
| Total Medicare Payment Amount | 261038.26 |
| Total Medicare Standardized Payment Amount | 246848.77 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 27 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 980 |
| Total Drug Medicare AllowedAmount | 550.11 |
| Total Drug Medicare PaymentAmount | 537.08 |
| Total Drug Medicare Standardized Payment Amount | 537.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 3940 |
| Number Of Medicare Beneficiaries With Medical Services | 785 |
| Total Medical Submitted Charge Amount | 508924 |
| Total Medical Medicare Allowed Amount | 345737.76 |
| Total Medical Medicare Payment Amount | 260501.18 |
| Total Medical Medicare Standardized Payment Amount | 246311.69 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 104 |
| Number Of Beneficiaries Age 65 to 74 | 182 |
| Number Of Beneficiaries Age 75 to 84 | 221 |
| Number Of Beneficiaries Age Greater 84 | 278 |
| Number Of Female Beneficiaries | 434 |
| Number Of Male Beneficiaries | 351 |
| Number Of Non Hispanic White Beneficiaries | 637 |
| Number Of Black or African American Beneficiaries | 123 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| 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 | 566 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 219 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 49 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.1127 |