| National Provider Identifier [NPI]: | 1356465553 |
| Last Name Of The Provider | TELELE |
| First Name Of The Provider | JIMA |
| 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 | 12164 CENTRAL AVE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MITCHELLVILLE |
| Zip Code Of The Provider | 207211944 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 465 |
| Number Of Medicare Beneficiaries | 59 |
| Total Submitted Charge Amount | 28645.64 |
| Total Medicare Allowed Amount | 23074.03 |
| Total Medicare Payment Amount | 16600.14 |
| Total Medicare Standardized Payment Amount | 15123.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 37 |
| Number Of Medicare Beneficiaries With Drug Services | 29 |
| Total Drug Submitted ChargeAmount | 693.5 |
| Total Drug Medicare AllowedAmount | 552.73 |
| Total Drug Medicare PaymentAmount | 537.71 |
| Total Drug Medicare Standardized Payment Amount | 537.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 428 |
| Number Of Medicare Beneficiaries With Medical Services | 59 |
| Total Medical Submitted Charge Amount | 27952.14 |
| Total Medical Medicare Allowed Amount | 22521.3 |
| Total Medical Medicare Payment Amount | 16062.43 |
| Total Medical Medicare Standardized Payment Amount | 14586.25 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 20 |
| Number Of Male Beneficiaries | 39 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 29 |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.6234 |