National Provider Identifier [NPI]: |
1750442422 |
Last Name Of The Provider |
DASGUPTA |
First Name Of The Provider |
SUNAVO |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1365 WILEY ROAD |
Street Address 2 Of The Provider |
SUITE 153 |
City Of The Provider |
SCHAUMBURG |
Zip Code Of The Provider |
601734357 |
State Code Of The Provider |
IL |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Pain Management |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
64 |
Number Of Services |
4554 |
Number Of Medicare Beneficiaries |
336 |
Total Submitted Charge Amount |
1351484.85 |
Total Medicare Allowed Amount |
173035.2 |
Total Medicare Payment Amount |
132326.12 |
Total Medicare Standardized Payment Amount |
121086.61 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
12 |
Number Of Drug Services |
2686 |
Number Of Medicare Beneficiaries With Drug Services |
117 |
Total Drug Submitted ChargeAmount |
116209.64 |
Total Drug Medicare AllowedAmount |
8315.28 |
Total Drug Medicare PaymentAmount |
6505.16 |
Total Drug Medicare Standardized Payment Amount |
6505.16 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
52 |
Number Of Medical Services |
1868 |
Number Of Medicare Beneficiaries With Medical Services |
336 |
Total Medical Submitted Charge Amount |
1235275.21 |
Total Medical Medicare Allowed Amount |
164719.92 |
Total Medical Medicare Payment Amount |
125820.96 |
Total Medical Medicare Standardized Payment Amount |
114581.45 |
Average Age Of Beneficiaries |
70 |
Number Of Beneficiaries Age Less65 |
77 |
Number Of Beneficiaries Age 65 to 74 |
139 |
Number Of Beneficiaries Age 75 to 84 |
94 |
Number Of Beneficiaries Age Greater 84 |
26 |
Number Of Female Beneficiaries |
212 |
Number Of Male Beneficiaries |
124 |
Number Of Non Hispanic White Beneficiaries |
257 |
Number Of Black or African American Beneficiaries |
46 |
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 |
|
Number Of Beneficiaries With Medicare Only Entitlement |
265 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
71 |
Percent Of With Atrial Fibrillation |
10 |
Percent Of With Alzheimers Disease or Dementia |
9 |
Percent Of With Asthma |
13 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
19 |
Percent Of With Chronic Kidney Disease |
25 |
Percent Of With Chronic Obstructive Pulmonary Disease |
19 |
Percent Of With Depression |
38 |
Percent Of With Diabetes |
37 |
Percent Of With Hyperlipidemia |
59 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
40 |
Percent Of With Osteoporosis |
9 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
4 |
Percent Of With Stroke |
4 |
Average HCC Risk Score Of Beneficiaries |
1.3567 |