| National Provider Identifier [NPI]: | 1083790117 |
| Last Name Of The Provider | MODY |
| First Name Of The Provider | VATSAL |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10832 LAUREL ST STE 101 |
| Street Address 2 Of The Provider | |
| City Of The Provider | RANCHO CUCAMONGA |
| Zip Code Of The Provider | 91730 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 6696 |
| Number Of Medicare Beneficiaries | 1000 |
| Total Submitted Charge Amount | 1105448 |
| Total Medicare Allowed Amount | 576552 |
| Total Medicare Payment Amount | 439471.02 |
| Total Medicare Standardized Payment Amount | 428356.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 360 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 27000 |
| Total Drug Medicare AllowedAmount | 19067.65 |
| Total Drug Medicare PaymentAmount | 14748.53 |
| Total Drug Medicare Standardized Payment Amount | 14748.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 6336 |
| Number Of Medicare Beneficiaries With Medical Services | 1000 |
| Total Medical Submitted Charge Amount | 1078448 |
| Total Medical Medicare Allowed Amount | 557484.35 |
| Total Medical Medicare Payment Amount | 424722.49 |
| Total Medical Medicare Standardized Payment Amount | 413607.69 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 379 |
| Number Of Beneficiaries Age 75 to 84 | 316 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 570 |
| Number Of Male Beneficiaries | 430 |
| Number Of Non Hispanic White Beneficiaries | 539 |
| Number Of Black or African American Beneficiaries | 100 |
| Number Of AsianPacific Islander Beneficiaries | 85 |
| Number Of Hispanic Beneficiaries | 260 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 615 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 385 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.1571 |