| National Provider Identifier [NPI]: | 1861474876 |
| Last Name Of The Provider | KOTHARI |
| First Name Of The Provider | TUSHAR |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MEDICAL VILLAGE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | EDGEWOOD |
| Zip Code Of The Provider | 410173403 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 173 |
| Number Of Services | 4860 |
| Number Of Medicare Beneficiaries | 3463 |
| Total Submitted Charge Amount | 481620 |
| Total Medicare Allowed Amount | 140602.43 |
| Total Medicare Payment Amount | 106698.33 |
| Total Medicare Standardized Payment Amount | 113721.93 |
| 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 | 173 |
| Number Of Medical Services | 4860 |
| Number Of Medicare Beneficiaries With Medical Services | 3463 |
| Total Medical Submitted Charge Amount | 481620 |
| Total Medical Medicare Allowed Amount | 140602.43 |
| Total Medical Medicare Payment Amount | 106698.33 |
| Total Medical Medicare Standardized Payment Amount | 113721.93 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 769 |
| Number Of Beneficiaries Age 65 to 74 | 1259 |
| Number Of Beneficiaries Age 75 to 84 | 915 |
| Number Of Beneficiaries Age Greater 84 | 520 |
| Number Of Female Beneficiaries | 2174 |
| Number Of Male Beneficiaries | 1289 |
| Number Of Non Hispanic White Beneficiaries | 3318 |
| Number Of Black or African American Beneficiaries | 83 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2586 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 877 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6944 |