| National Provider Identifier [NPI]: | 1821223587 |
| Last Name Of The Provider | KANDAVANAM |
| First Name Of The Provider | RAJ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1590 S SR 15A |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | DELAND |
| Zip Code Of The Provider | 327207817 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 1540 |
| Number Of Medicare Beneficiaries | 415 |
| Total Submitted Charge Amount | 175571.96 |
| Total Medicare Allowed Amount | 137839.81 |
| Total Medicare Payment Amount | 98591.72 |
| Total Medicare Standardized Payment Amount | 99318.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 134 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 4970 |
| Total Drug Medicare AllowedAmount | 1058.92 |
| Total Drug Medicare PaymentAmount | 957.06 |
| Total Drug Medicare Standardized Payment Amount | 957.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1406 |
| Number Of Medicare Beneficiaries With Medical Services | 415 |
| Total Medical Submitted Charge Amount | 170601.96 |
| Total Medical Medicare Allowed Amount | 136780.89 |
| Total Medical Medicare Payment Amount | 97634.66 |
| Total Medical Medicare Standardized Payment Amount | 98361.34 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 34 |
| Number Of Beneficiaries Age 65 to 74 | 156 |
| Number Of Beneficiaries Age 75 to 84 | 152 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 215 |
| Number Of Male Beneficiaries | 200 |
| Number Of Non Hispanic White Beneficiaries | 388 |
| Number Of Black or African American Beneficiaries | 12 |
| 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 | 375 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 40 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2418 |