| National Provider Identifier [NPI]: | 1801976923 |
| Last Name Of The Provider | WALALIYADDA |
| First Name Of The Provider | RANMALI |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1448 E CENTER ST |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | POCATELLO |
| Zip Code Of The Provider | 832014132 |
| State Code Of The Provider | ID |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 5264 |
| Number Of Medicare Beneficiaries | 433 |
| Total Submitted Charge Amount | 691350.47 |
| Total Medicare Allowed Amount | 179185.63 |
| Total Medicare Payment Amount | 140812.59 |
| Total Medicare Standardized Payment Amount | 175218.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1505 |
| Number Of Medicare Beneficiaries With Drug Services | 286 |
| Total Drug Submitted ChargeAmount | 45334 |
| Total Drug Medicare AllowedAmount | 11983.97 |
| Total Drug Medicare PaymentAmount | 9343.11 |
| Total Drug Medicare Standardized Payment Amount | 9343.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 3759 |
| Number Of Medicare Beneficiaries With Medical Services | 433 |
| Total Medical Submitted Charge Amount | 646016.47 |
| Total Medical Medicare Allowed Amount | 167201.66 |
| Total Medical Medicare Payment Amount | 131469.48 |
| Total Medical Medicare Standardized Payment Amount | 165875.21 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 201 |
| Number Of Beneficiaries Age 75 to 84 | 108 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 317 |
| Number Of Male Beneficiaries | 116 |
| Number Of Non Hispanic White Beneficiaries | 406 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 336 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 97 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 31 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 31 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1372 |