| National Provider Identifier [NPI]: | 1497839328 |
| Last Name Of The Provider | BOTHRA |
| First Name Of The Provider | RAJENDRA |
| 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 | 27423 VAN DYKE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 480932867 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 13470 |
| Number Of Medicare Beneficiaries | 712 |
| Total Submitted Charge Amount | 2893427 |
| Total Medicare Allowed Amount | 921046.78 |
| Total Medicare Payment Amount | 710135.75 |
| Total Medicare Standardized Payment Amount | 602206.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1160 |
| Number Of Medicare Beneficiaries With Drug Services | 460 |
| Total Drug Submitted ChargeAmount | 30710 |
| Total Drug Medicare AllowedAmount | 6043.6 |
| Total Drug Medicare PaymentAmount | 4671.59 |
| Total Drug Medicare Standardized Payment Amount | 4671.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 12310 |
| Number Of Medicare Beneficiaries With Medical Services | 712 |
| Total Medical Submitted Charge Amount | 2862717 |
| Total Medical Medicare Allowed Amount | 915003.18 |
| Total Medical Medicare Payment Amount | 705464.16 |
| Total Medical Medicare Standardized Payment Amount | 597534.9 |
| Average Age Of Beneficiaries | 54 |
| Number Of Beneficiaries Age Less65 | 550 |
| Number Of Beneficiaries Age 65 to 74 | 102 |
| Number Of Beneficiaries Age 75 to 84 | 44 |
| Number Of Beneficiaries Age Greater 84 | 16 |
| Number Of Female Beneficiaries | 415 |
| Number Of Male Beneficiaries | 297 |
| Number Of Non Hispanic White Beneficiaries | 296 |
| Number Of Black or African American Beneficiaries | 399 |
| 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 | 233 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 479 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5816 |