| National Provider Identifier [NPI]: | 1649444118 |
| Last Name Of The Provider | RAJAN |
| First Name Of The Provider | SUBHA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1405 MILL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW LONDON |
| Zip Code Of The Provider | 549612155 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 1082 |
| Number Of Medicare Beneficiaries | 208 |
| Total Submitted Charge Amount | 102440.5 |
| Total Medicare Allowed Amount | 35741.27 |
| Total Medicare Payment Amount | 27004.68 |
| Total Medicare Standardized Payment Amount | 28122.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 1959 |
| Total Drug Medicare AllowedAmount | 1053.99 |
| Total Drug Medicare PaymentAmount | 1022.34 |
| Total Drug Medicare Standardized Payment Amount | 1022.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 130 |
| Number Of Medical Services | 1037 |
| Number Of Medicare Beneficiaries With Medical Services | 208 |
| Total Medical Submitted Charge Amount | 100481.5 |
| Total Medical Medicare Allowed Amount | 34687.28 |
| Total Medical Medicare Payment Amount | 25982.34 |
| Total Medical Medicare Standardized Payment Amount | 27100.03 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 62 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 128 |
| Number Of Male Beneficiaries | 80 |
| 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 | 140 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 68 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3628 |