| National Provider Identifier [NPI]: | 1477586428 |
| Last Name Of The Provider | KOLLURI |
| First Name Of The Provider | PAVAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 204 TALCOTT RIDGE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH WINDSOR |
| Zip Code Of The Provider | 060742394 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 3895 |
| Number Of Medicare Beneficiaries | 2155 |
| Total Submitted Charge Amount | 1001717.77 |
| Total Medicare Allowed Amount | 393657.63 |
| Total Medicare Payment Amount | 305200.91 |
| Total Medicare Standardized Payment Amount | 317239.56 |
| 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 | 58 |
| Number Of Medical Services | 3895 |
| Number Of Medicare Beneficiaries With Medical Services | 2155 |
| Total Medical Submitted Charge Amount | 1001717.77 |
| Total Medical Medicare Allowed Amount | 393657.63 |
| Total Medical Medicare Payment Amount | 305200.91 |
| Total Medical Medicare Standardized Payment Amount | 317239.56 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 767 |
| Number Of Beneficiaries Age 65 to 74 | 639 |
| Number Of Beneficiaries Age 75 to 84 | 496 |
| Number Of Beneficiaries Age Greater 84 | 253 |
| Number Of Female Beneficiaries | 1190 |
| Number Of Male Beneficiaries | 965 |
| Number Of Non Hispanic White Beneficiaries | 2091 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1182 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 973 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 23 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 44 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.9027 |