| National Provider Identifier [NPI]: | 1699745265 |
| Last Name Of The Provider | KOTTAMASU |
| First Name Of The Provider | SAMBASIVA |
| 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 | 3400 N CENTER RD |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | SAGINAW |
| Zip Code Of The Provider | 486037920 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 3996 |
| Number Of Medicare Beneficiaries | 2988 |
| Total Submitted Charge Amount | 262156 |
| Total Medicare Allowed Amount | 129779.15 |
| Total Medicare Payment Amount | 98274.17 |
| Total Medicare Standardized Payment Amount | 101890.63 |
| 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 | 138 |
| Number Of Medical Services | 3996 |
| Number Of Medicare Beneficiaries With Medical Services | 2988 |
| Total Medical Submitted Charge Amount | 262156 |
| Total Medical Medicare Allowed Amount | 129779.15 |
| Total Medical Medicare Payment Amount | 98274.17 |
| Total Medical Medicare Standardized Payment Amount | 101890.63 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 681 |
| Number Of Beneficiaries Age 65 to 74 | 1028 |
| Number Of Beneficiaries Age 75 to 84 | 836 |
| Number Of Beneficiaries Age Greater 84 | 443 |
| Number Of Female Beneficiaries | 1738 |
| Number Of Male Beneficiaries | 1250 |
| Number Of Non Hispanic White Beneficiaries | 2293 |
| Number Of Black or African American Beneficiaries | 548 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 109 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2153 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 835 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8699 |