| National Provider Identifier [NPI]: | 1023097839 |
| Last Name Of The Provider | PURI |
| First Name Of The Provider | SANJEEV |
| 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 | 350 JOHN DEERE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOLINE |
| Zip Code Of The Provider | 612656899 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 15012 |
| Number Of Medicare Beneficiaries | 2934 |
| Total Submitted Charge Amount | 2360317.6 |
| Total Medicare Allowed Amount | 954827.22 |
| Total Medicare Payment Amount | 715783.41 |
| Total Medicare Standardized Payment Amount | 737539.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 6326 |
| Number Of Medicare Beneficiaries With Drug Services | 271 |
| Total Drug Submitted ChargeAmount | 53280 |
| Total Drug Medicare AllowedAmount | 46431.96 |
| Total Drug Medicare PaymentAmount | 36068.5 |
| Total Drug Medicare Standardized Payment Amount | 36068.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 8686 |
| Number Of Medicare Beneficiaries With Medical Services | 2933 |
| Total Medical Submitted Charge Amount | 2307037.6 |
| Total Medical Medicare Allowed Amount | 908395.26 |
| Total Medical Medicare Payment Amount | 679714.91 |
| Total Medical Medicare Standardized Payment Amount | 701470.56 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 243 |
| Number Of Beneficiaries Age 65 to 74 | 1216 |
| Number Of Beneficiaries Age 75 to 84 | 964 |
| Number Of Beneficiaries Age Greater 84 | 511 |
| Number Of Female Beneficiaries | 1526 |
| Number Of Male Beneficiaries | 1408 |
| Number Of Non Hispanic White Beneficiaries | 2689 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2607 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 327 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3734 |