| National Provider Identifier [NPI]: | 1962447805 |
| Last Name Of The Provider | KETHA |
| First Name Of The Provider | SUMANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2925 SKYWAY CIR N |
| Street Address 2 Of The Provider | |
| City Of The Provider | IRVING |
| Zip Code Of The Provider | 750383510 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 4655 |
| Number Of Medicare Beneficiaries | 820 |
| Total Submitted Charge Amount | 684859.43 |
| Total Medicare Allowed Amount | 416103.71 |
| Total Medicare Payment Amount | 310548.96 |
| Total Medicare Standardized Payment Amount | 312487.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1149.54 |
| Total Drug Medicare AllowedAmount | 662.22 |
| Total Drug Medicare PaymentAmount | 641.25 |
| Total Drug Medicare Standardized Payment Amount | 641.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 4607 |
| Number Of Medicare Beneficiaries With Medical Services | 820 |
| Total Medical Submitted Charge Amount | 683709.89 |
| Total Medical Medicare Allowed Amount | 415441.49 |
| Total Medical Medicare Payment Amount | 309907.71 |
| Total Medical Medicare Standardized Payment Amount | 311846.33 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 294 |
| Number Of Beneficiaries Age 65 to 74 | 198 |
| Number Of Beneficiaries Age 75 to 84 | 188 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 456 |
| Number Of Male Beneficiaries | 364 |
| Number Of Non Hispanic White Beneficiaries | 303 |
| Number Of Black or African American Beneficiaries | 378 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 263 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 557 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 49 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 58 |
| Percent Of With Diabetes | 61 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.6803 |