| National Provider Identifier [NPI]: | 1336331388 |
| Last Name Of The Provider | NUTHAKKI |
| First Name Of The Provider | MOHAN |
| 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 | 3130 N DIXIE HWY |
| Street Address 2 Of The Provider | SUITE107 |
| City Of The Provider | TROY |
| Zip Code Of The Provider | 453731337 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 109 |
| Number Of Services | 96425 |
| Number Of Medicare Beneficiaries | 470 |
| Total Submitted Charge Amount | 2454064.98 |
| Total Medicare Allowed Amount | 1211205.58 |
| Total Medicare Payment Amount | 935009.63 |
| Total Medicare Standardized Payment Amount | 936864.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 56 |
| Number Of Drug Services | 92368 |
| Number Of Medicare Beneficiaries With Drug Services | 137 |
| Total Drug Submitted ChargeAmount | 1889965.54 |
| Total Drug Medicare AllowedAmount | 940586.58 |
| Total Drug Medicare PaymentAmount | 735030.32 |
| Total Drug Medicare Standardized Payment Amount | 735030.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 4057 |
| Number Of Medicare Beneficiaries With Medical Services | 470 |
| Total Medical Submitted Charge Amount | 564099.44 |
| Total Medical Medicare Allowed Amount | 270619 |
| Total Medical Medicare Payment Amount | 199979.31 |
| Total Medical Medicare Standardized Payment Amount | 201833.88 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 180 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 277 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 455 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 404 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 41 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.8459 |