| National Provider Identifier [NPI]: | 1891712253 |
| Last Name Of The Provider | GUPTA |
| First Name Of The Provider | SAMARDEEP |
| 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 | 1500 E MEDICAL CENTER DRIVE |
| Street Address 2 Of The Provider | 3RD FLOOR TAUBMAN CENTER RECP A |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 48109 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 344 |
| Number Of Medicare Beneficiaries | 87 |
| Total Submitted Charge Amount | 56221 |
| Total Medicare Allowed Amount | 17694.61 |
| Total Medicare Payment Amount | 12559.63 |
| Total Medicare Standardized Payment Amount | 11997.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 167 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 5055 |
| Total Drug Medicare AllowedAmount | 1774.09 |
| Total Drug Medicare PaymentAmount | 1275.63 |
| Total Drug Medicare Standardized Payment Amount | 1275.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 177 |
| Number Of Medicare Beneficiaries With Medical Services | 87 |
| Total Medical Submitted Charge Amount | 51166 |
| Total Medical Medicare Allowed Amount | 15920.52 |
| Total Medical Medicare Payment Amount | 11284 |
| Total Medical Medicare Standardized Payment Amount | 10721.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 27 |
| Number Of Beneficiaries Age 75 to 84 | 25 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 52 |
| Number Of Male Beneficiaries | 35 |
| Number Of Non Hispanic White Beneficiaries | 64 |
| Number Of Black or African American Beneficiaries | |
| 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 | 53 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 34 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 23 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1871 |