| National Provider Identifier [NPI]: | 1366402273 |
| Last Name Of The Provider | PUNUKOLLU |
| First Name Of The Provider | PAVAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 730 W MARKET ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LIMA |
| Zip Code Of The Provider | 458014602 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 262 |
| Number Of Services | 5804 |
| Number Of Medicare Beneficiaries | 3340 |
| Total Submitted Charge Amount | 1137166 |
| Total Medicare Allowed Amount | 261642.64 |
| Total Medicare Payment Amount | 200833.92 |
| Total Medicare Standardized Payment Amount | 207096.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 262 |
| Number Of Medical Services | 5804 |
| Number Of Medicare Beneficiaries With Medical Services | 3340 |
| Total Medical Submitted Charge Amount | 1137166 |
| Total Medical Medicare Allowed Amount | 261642.64 |
| Total Medical Medicare Payment Amount | 200833.92 |
| Total Medical Medicare Standardized Payment Amount | 207096.59 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 625 |
| Number Of Beneficiaries Age 65 to 74 | 1144 |
| Number Of Beneficiaries Age 75 to 84 | 1011 |
| Number Of Beneficiaries Age Greater 84 | 560 |
| Number Of Female Beneficiaries | 1886 |
| Number Of Male Beneficiaries | 1454 |
| Number Of Non Hispanic White Beneficiaries | 3066 |
| Number Of Black or African American Beneficiaries | 191 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2539 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 801 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7124 |