| National Provider Identifier [NPI]: | 1174522189 |
| Last Name Of The Provider | SRIRATANA |
| First Name Of The Provider | PRAMERN |
| 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 | 407 E VERNON AVE |
| Street Address 2 Of The Provider | STE 104 |
| City Of The Provider | NORMAL |
| Zip Code Of The Provider | 617613813 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 152 |
| Number Of Services | 287924 |
| Number Of Medicare Beneficiaries | 976 |
| Total Submitted Charge Amount | 10340452 |
| Total Medicare Allowed Amount | 5145242.85 |
| Total Medicare Payment Amount | 4018554.61 |
| Total Medicare Standardized Payment Amount | 4017338.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 72 |
| Number Of Drug Services | 259952 |
| Number Of Medicare Beneficiaries With Drug Services | 301 |
| Total Drug Submitted ChargeAmount | 6969491 |
| Total Drug Medicare AllowedAmount | 4082978.65 |
| Total Drug Medicare PaymentAmount | 3187159.01 |
| Total Drug Medicare Standardized Payment Amount | 3187159.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 27972 |
| Number Of Medicare Beneficiaries With Medical Services | 976 |
| Total Medical Submitted Charge Amount | 3370961 |
| Total Medical Medicare Allowed Amount | 1062264.2 |
| Total Medical Medicare Payment Amount | 831395.6 |
| Total Medical Medicare Standardized Payment Amount | 830179.58 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 116 |
| Number Of Beneficiaries Age 65 to 74 | 373 |
| Number Of Beneficiaries Age 75 to 84 | 312 |
| Number Of Beneficiaries Age Greater 84 | 175 |
| Number Of Female Beneficiaries | 594 |
| Number Of Male Beneficiaries | 382 |
| Number Of Non Hispanic White Beneficiaries | 916 |
| Number Of Black or African American Beneficiaries | 44 |
| 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 | 794 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 182 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 36 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.7173 |