| National Provider Identifier [NPI]: | 1346217973 |
| Last Name Of The Provider | GHODADRA |
| First Name Of The Provider | TONY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 SKYLINE DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 383013901 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 220 |
| Number Of Services | 10572 |
| Number Of Medicare Beneficiaries | 6336 |
| Total Submitted Charge Amount | 1138713 |
| Total Medicare Allowed Amount | 328463.28 |
| Total Medicare Payment Amount | 257542.47 |
| Total Medicare Standardized Payment Amount | 273558.24 |
| 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 | 220 |
| Number Of Medical Services | 10572 |
| Number Of Medicare Beneficiaries With Medical Services | 6336 |
| Total Medical Submitted Charge Amount | 1138713 |
| Total Medical Medicare Allowed Amount | 328463.28 |
| Total Medical Medicare Payment Amount | 257542.47 |
| Total Medical Medicare Standardized Payment Amount | 273558.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1453 |
| Number Of Beneficiaries Age 65 to 74 | 2427 |
| Number Of Beneficiaries Age 75 to 84 | 1690 |
| Number Of Beneficiaries Age Greater 84 | 766 |
| Number Of Female Beneficiaries | 4151 |
| Number Of Male Beneficiaries | 2185 |
| Number Of Non Hispanic White Beneficiaries | 5094 |
| Number Of Black or African American Beneficiaries | 1172 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2130 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6757 |