National Provider Identifier [NPI]: |
1417957457 |
Last Name Of The Provider |
NAGUBADI |
First Name Of The Provider |
SUBBA |
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 |
1101 GLENDALE BLVD |
Street Address 2 Of The Provider |
STE 111 |
City Of The Provider |
VALPARAISO |
Zip Code Of The Provider |
463833767 |
State Code Of The Provider |
IN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Urology |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
54 |
Number Of Services |
4011 |
Number Of Medicare Beneficiaries |
961 |
Total Submitted Charge Amount |
2571773 |
Total Medicare Allowed Amount |
507960.94 |
Total Medicare Payment Amount |
381356.81 |
Total Medicare Standardized Payment Amount |
403068.12 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
2 |
Number Of Drug Services |
1087 |
Number Of Medicare Beneficiaries With Drug Services |
110 |
Total Drug Submitted ChargeAmount |
1058192 |
Total Drug Medicare AllowedAmount |
231219.22 |
Total Drug Medicare PaymentAmount |
178026.16 |
Total Drug Medicare Standardized Payment Amount |
178026.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
52 |
Number Of Medical Services |
2924 |
Number Of Medicare Beneficiaries With Medical Services |
961 |
Total Medical Submitted Charge Amount |
1513581 |
Total Medical Medicare Allowed Amount |
276741.72 |
Total Medical Medicare Payment Amount |
203330.65 |
Total Medical Medicare Standardized Payment Amount |
225041.96 |
Average Age Of Beneficiaries |
75 |
Number Of Beneficiaries Age Less65 |
87 |
Number Of Beneficiaries Age 65 to 74 |
372 |
Number Of Beneficiaries Age 75 to 84 |
352 |
Number Of Beneficiaries Age Greater 84 |
150 |
Number Of Female Beneficiaries |
203 |
Number Of Male Beneficiaries |
758 |
Number Of Non Hispanic White Beneficiaries |
908 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
22 |
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
12 |
Number Of Beneficiaries With Medicare Only Entitlement |
833 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
128 |
Percent Of With Atrial Fibrillation |
14 |
Percent Of With Alzheimers Disease or Dementia |
14 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
24 |
Percent Of With Heart Failure |
21 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
30 |
Percent Of With Hyperlipidemia |
58 |
Percent Of With Hypertension |
71 |
Percent Of With Ischemic Heart Disease |
42 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
40 |
Percent Of With Schizophrenia Other PsychoticDisorders |
5 |
Percent Of With Stroke |
6 |
Average HCC Risk Score Of Beneficiaries |
1.1982 |