| National Provider Identifier [NPI]: | 1326084435 |
| Last Name Of The Provider | KODIYAN |
| First Name Of The Provider | VARGHESE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | LCSW,PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1601 W REYNOLDS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PLANT CITY |
| Zip Code Of The Provider | 335634748 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Licensed Clinical Social Worker |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 6 |
| Number Of Services | 2041 |
| Number Of Medicare Beneficiaries | 136 |
| Total Submitted Charge Amount | 253550 |
| Total Medicare Allowed Amount | 136010.31 |
| Total Medicare Payment Amount | 105726.18 |
| Total Medicare Standardized Payment Amount | 104839.16 |
| 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 | 6 |
| Number Of Medical Services | 2041 |
| Number Of Medicare Beneficiaries With Medical Services | 136 |
| Total Medical Submitted Charge Amount | 253550 |
| Total Medical Medicare Allowed Amount | 136010.31 |
| Total Medical Medicare Payment Amount | 105726.18 |
| Total Medical Medicare Standardized Payment Amount | 104839.16 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 76 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | 12 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 73 |
| Number Of Male Beneficiaries | 63 |
| Number Of Non Hispanic White Beneficiaries | 94 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 26 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 110 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 75 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 66 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 1.9159 |