| National Provider Identifier [NPI]: | 1801874821 |
| Last Name Of The Provider | VASA |
| First Name Of The Provider | NIRMALA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | SOUTHSIDE VIRGINIA TRAINING CENTER |
| Street Address 2 Of The Provider | 26317 WEST WASHINGTON STREET EXT |
| City Of The Provider | PETERSBURG |
| Zip Code Of The Provider | 238030030 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 4 |
| Number Of Services | 51 |
| Number Of Medicare Beneficiaries | 39 |
| Total Submitted Charge Amount | 1691 |
| Total Medicare Allowed Amount | 1328.67 |
| Total Medicare Payment Amount | 1157.96 |
| Total Medicare Standardized Payment Amount | 1166.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 33 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 792 |
| Total Drug Medicare AllowedAmount | 593.34 |
| Total Drug Medicare PaymentAmount | 581.46 |
| Total Drug Medicare Standardized Payment Amount | 581.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 18 |
| Number Of Medicare Beneficiaries With Medical Services | 14 |
| Total Medical Submitted Charge Amount | 899 |
| Total Medical Medicare Allowed Amount | 735.33 |
| Total Medical Medicare Payment Amount | 576.5 |
| Total Medical Medicare Standardized Payment Amount | 585.34 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 0 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 23 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | 27 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| 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 | 74 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 67 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1023 |