| National Provider Identifier [NPI]: | 1427207968 |
| Last Name Of The Provider | TUMMALA |
| First Name Of The Provider | VENKAT |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MBBS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7468 DRY CREEK DR |
| Street Address 2 Of The Provider | APT # 3A |
| City Of The Provider | GRAND BLANC |
| Zip Code Of The Provider | 484396316 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 282 |
| Number Of Services | 4023 |
| Number Of Medicare Beneficiaries | 1172 |
| Total Submitted Charge Amount | 992797.4 |
| Total Medicare Allowed Amount | 235150.72 |
| Total Medicare Payment Amount | 183168.69 |
| Total Medicare Standardized Payment Amount | 179705.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1510 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 3220 |
| Total Drug Medicare AllowedAmount | 317.89 |
| Total Drug Medicare PaymentAmount | 238.92 |
| Total Drug Medicare Standardized Payment Amount | 238.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 280 |
| Number Of Medical Services | 2513 |
| Number Of Medicare Beneficiaries With Medical Services | 1172 |
| Total Medical Submitted Charge Amount | 989577.4 |
| Total Medical Medicare Allowed Amount | 234832.83 |
| Total Medical Medicare Payment Amount | 182929.77 |
| Total Medical Medicare Standardized Payment Amount | 179466.7 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 212 |
| Number Of Beneficiaries Age 65 to 74 | 381 |
| Number Of Beneficiaries Age 75 to 84 | 380 |
| Number Of Beneficiaries Age Greater 84 | 199 |
| Number Of Female Beneficiaries | 619 |
| Number Of Male Beneficiaries | 553 |
| Number Of Non Hispanic White Beneficiaries | 993 |
| Number Of Black or African American Beneficiaries | 119 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 46 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 845 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 327 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.7515 |