| National Provider Identifier [NPI]: | 1205897774 |
| Last Name Of The Provider | GHOSH |
| First Name Of The Provider | SUBHA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1654 UPHAM DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432101250 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 8668 |
| Number Of Medicare Beneficiaries | 4649 |
| Total Submitted Charge Amount | 539282 |
| Total Medicare Allowed Amount | 140605.96 |
| Total Medicare Payment Amount | 105382.99 |
| Total Medicare Standardized Payment Amount | 110941.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 9 |
| Number Of Medical Services | 8668 |
| Number Of Medicare Beneficiaries With Medical Services | 4649 |
| Total Medical Submitted Charge Amount | 539282 |
| Total Medical Medicare Allowed Amount | 140605.96 |
| Total Medical Medicare Payment Amount | 105382.99 |
| Total Medical Medicare Standardized Payment Amount | 110941.26 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 1480 |
| Number Of Beneficiaries Age 65 to 74 | 1816 |
| Number Of Beneficiaries Age 75 to 84 | 1015 |
| Number Of Beneficiaries Age Greater 84 | 338 |
| Number Of Female Beneficiaries | 2243 |
| Number Of Male Beneficiaries | 2406 |
| Number Of Non Hispanic White Beneficiaries | 3666 |
| Number Of Black or African American Beneficiaries | 805 |
| Number Of AsianPacific Islander Beneficiaries | 51 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2975 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1674 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.4495 |