| National Provider Identifier [NPI]: | 1942373931 |
| Last Name Of The Provider | NANDRA |
| First Name Of The Provider | MUKHTAR |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 115 E SOUTH ST |
| Street Address 2 Of The Provider | UNIT F |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 605451417 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 896 |
| Number Of Medicare Beneficiaries | 196 |
| Total Submitted Charge Amount | 102985 |
| Total Medicare Allowed Amount | 64494.19 |
| Total Medicare Payment Amount | 43664.91 |
| Total Medicare Standardized Payment Amount | 45325.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 16 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 600 |
| Total Drug Medicare AllowedAmount | 72.18 |
| Total Drug Medicare PaymentAmount | 57.37 |
| Total Drug Medicare Standardized Payment Amount | 57.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 880 |
| Number Of Medicare Beneficiaries With Medical Services | 196 |
| Total Medical Submitted Charge Amount | 102385 |
| Total Medical Medicare Allowed Amount | 64422.01 |
| Total Medical Medicare Payment Amount | 43607.54 |
| Total Medical Medicare Standardized Payment Amount | 45267.68 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 77 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | 27 |
| Number Of Female Beneficiaries | 111 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 130 |
| Number Of Black or African American Beneficiaries | 11 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 42 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 65 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 131 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3859 |