| National Provider Identifier [NPI]: | 1265452528 |
| Last Name Of The Provider | SHAH |
| First Name Of The Provider | CHANDRESH |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 STATE HOSPITAL DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANVILLE |
| Zip Code Of The Provider | 178219198 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 9 |
| Number Of Services | 938 |
| Number Of Medicare Beneficiaries | 79 |
| Total Submitted Charge Amount | 50541.49 |
| Total Medicare Allowed Amount | 50505.85 |
| Total Medicare Payment Amount | 39767.74 |
| Total Medicare Standardized Payment Amount | 41855.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 823.62 |
| Total Drug Medicare AllowedAmount | 823.62 |
| Total Drug Medicare PaymentAmount | 807.14 |
| Total Drug Medicare Standardized Payment Amount | 807.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 6 |
| Number Of Medical Services | 912 |
| Number Of Medicare Beneficiaries With Medical Services | 79 |
| Total Medical Submitted Charge Amount | 49717.87 |
| Total Medical Medicare Allowed Amount | 49682.23 |
| Total Medical Medicare Payment Amount | 38960.6 |
| Total Medical Medicare Standardized Payment Amount | 41048.8 |
| Average Age Of Beneficiaries | 56 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 44 |
| Number Of Male Beneficiaries | 35 |
| Number Of Non Hispanic White Beneficiaries | 68 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 31 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 25 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 75 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4767 |