| National Provider Identifier [NPI]: | 1780790717 |
| Last Name Of The Provider | POLA |
| First Name Of The Provider | BHARATH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 325 N CALDWELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STAUNTON |
| Zip Code Of The Provider | 620881421 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1022 |
| Number Of Medicare Beneficiaries | 129 |
| Total Submitted Charge Amount | 96502 |
| Total Medicare Allowed Amount | 71293.8 |
| Total Medicare Payment Amount | 52240.02 |
| Total Medicare Standardized Payment Amount | 52173.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 656 |
| Total Drug Medicare AllowedAmount | 361.53 |
| Total Drug Medicare PaymentAmount | 347.47 |
| Total Drug Medicare Standardized Payment Amount | 347.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 1004 |
| Number Of Medicare Beneficiaries With Medical Services | 129 |
| Total Medical Submitted Charge Amount | 95846 |
| Total Medical Medicare Allowed Amount | 70932.27 |
| Total Medical Medicare Payment Amount | 51892.55 |
| Total Medical Medicare Standardized Payment Amount | 51826.4 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 56 |
| Number Of Beneficiaries Age 75 to 84 | 28 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 60 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | 102 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.3954 |