| National Provider Identifier [NPI]: | 1023075777 |
| Last Name Of The Provider | KORA |
| First Name Of The Provider | VIDYA |
| 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 | 3723 FRANKLIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MICHIGAN CITY |
| Zip Code Of The Provider | 463607310 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 111 |
| Number Of Services | 8401 |
| Number Of Medicare Beneficiaries | 997 |
| Total Submitted Charge Amount | 677634 |
| Total Medicare Allowed Amount | 440280.69 |
| Total Medicare Payment Amount | 316740.24 |
| Total Medicare Standardized Payment Amount | 332003.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 1008 |
| Number Of Medicare Beneficiaries With Drug Services | 403 |
| Total Drug Submitted ChargeAmount | 25395 |
| Total Drug Medicare AllowedAmount | 16743.67 |
| Total Drug Medicare PaymentAmount | 15813.39 |
| Total Drug Medicare Standardized Payment Amount | 15813.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 7393 |
| Number Of Medicare Beneficiaries With Medical Services | 996 |
| Total Medical Submitted Charge Amount | 652239 |
| Total Medical Medicare Allowed Amount | 423537.02 |
| Total Medical Medicare Payment Amount | 300926.85 |
| Total Medical Medicare Standardized Payment Amount | 316189.87 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 254 |
| Number Of Beneficiaries Age 65 to 74 | 359 |
| Number Of Beneficiaries Age 75 to 84 | 258 |
| Number Of Beneficiaries Age Greater 84 | 126 |
| Number Of Female Beneficiaries | 573 |
| Number Of Male Beneficiaries | 424 |
| Number Of Non Hispanic White Beneficiaries | 768 |
| Number Of Black or African American Beneficiaries | 206 |
| 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 | 691 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 306 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.408 |