| National Provider Identifier [NPI]: | 1851577241 |
| Last Name Of The Provider | MIRMIRA |
| First Name Of The Provider | VIJAY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1901 W KETTLEMAN LN |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | LODI |
| Zip Code Of The Provider | 952424337 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 793 |
| Number Of Medicare Beneficiaries | 310 |
| Total Submitted Charge Amount | 165127 |
| Total Medicare Allowed Amount | 65160.04 |
| Total Medicare Payment Amount | 44828.09 |
| Total Medicare Standardized Payment Amount | 39646.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 135 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 6538 |
| Total Drug Medicare AllowedAmount | 2119.77 |
| Total Drug Medicare PaymentAmount | 2056.21 |
| Total Drug Medicare Standardized Payment Amount | 2056.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 658 |
| Number Of Medicare Beneficiaries With Medical Services | 310 |
| Total Medical Submitted Charge Amount | 158589 |
| Total Medical Medicare Allowed Amount | 63040.27 |
| Total Medical Medicare Payment Amount | 42771.88 |
| Total Medical Medicare Standardized Payment Amount | 37590.7 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 18 |
| Number Of Beneficiaries Age 65 to 74 | 170 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 60 |
| Number Of Female Beneficiaries | 178 |
| Number Of Male Beneficiaries | 132 |
| Number Of Non Hispanic White Beneficiaries | 220 |
| Number Of Black or African American Beneficiaries | 17 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.8996 |