| National Provider Identifier [NPI]: | 1730156993 |
| Last Name Of The Provider | BOLLA |
| First Name Of The Provider | RAVISANKAR |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 25200 CENTER RIDGE RD |
| Street Address 2 Of The Provider | #1100 |
| City Of The Provider | WESTLAKE |
| Zip Code Of The Provider | 44145 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 82 |
| Number Of Services | 6251 |
| Number Of Medicare Beneficiaries | 1543 |
| Total Submitted Charge Amount | 1408494.28 |
| Total Medicare Allowed Amount | 521559.63 |
| Total Medicare Payment Amount | 398836.33 |
| Total Medicare Standardized Payment Amount | 411843.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 842 |
| Number Of Medicare Beneficiaries With Drug Services | 115 |
| Total Drug Submitted ChargeAmount | 33321.28 |
| Total Drug Medicare AllowedAmount | 23483.26 |
| Total Drug Medicare PaymentAmount | 18410.84 |
| Total Drug Medicare Standardized Payment Amount | 18410.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 79 |
| Number Of Medical Services | 5409 |
| Number Of Medicare Beneficiaries With Medical Services | 1543 |
| Total Medical Submitted Charge Amount | 1375173 |
| Total Medical Medicare Allowed Amount | 498076.37 |
| Total Medical Medicare Payment Amount | 380425.49 |
| Total Medical Medicare Standardized Payment Amount | 393432.53 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 238 |
| Number Of Beneficiaries Age 65 to 74 | 585 |
| Number Of Beneficiaries Age 75 to 84 | 426 |
| Number Of Beneficiaries Age Greater 84 | 294 |
| Number Of Female Beneficiaries | 827 |
| Number Of Male Beneficiaries | 716 |
| Number Of Non Hispanic White Beneficiaries | 1266 |
| Number Of Black or African American Beneficiaries | 95 |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| Number Of Hispanic Beneficiaries | 124 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1063 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 480 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7887 |