| National Provider Identifier [NPI]: | 1972729283 |
| Last Name Of The Provider | MUSHYAM |
| First Name Of The Provider | AMITHA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 180 SOUTH THIRD STREET |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | BELLEVILLE |
| Zip Code Of The Provider | 62220 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 475 |
| Number Of Medicare Beneficiaries | 289 |
| Total Submitted Charge Amount | 80895.96 |
| Total Medicare Allowed Amount | 35367.25 |
| Total Medicare Payment Amount | 24751.87 |
| Total Medicare Standardized Payment Amount | 24040.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1245 |
| Total Drug Medicare AllowedAmount | 154.53 |
| Total Drug Medicare PaymentAmount | 116.27 |
| Total Drug Medicare Standardized Payment Amount | 116.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 425 |
| Number Of Medicare Beneficiaries With Medical Services | 289 |
| Total Medical Submitted Charge Amount | 79650.96 |
| Total Medical Medicare Allowed Amount | 35212.72 |
| Total Medical Medicare Payment Amount | 24635.6 |
| Total Medical Medicare Standardized Payment Amount | 23924.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 148 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 209 |
| Number Of Male Beneficiaries | 80 |
| Number Of Non Hispanic White Beneficiaries | 265 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 248 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9055 |